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General NPI Number Information
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NPI Number | 1144746728
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Entity Type | Organization
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Legal Business Name | HERBERT S WILMER DDS PA
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Dates
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Enumeration Date | 08/16/2017
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Last Update Date | 08/16/2017
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Provider Practice Location Address
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Address Line | 3718 N NC 16 BUSINESS HWY
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City | DENVER
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State | NC
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Zip | 28037-8179
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Country | US
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Telephone | 704-483-5501
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Fax | 704-483-5501
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Provider Business Mailing Address
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Address Line | PO BOX 154
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City | DENVER
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State | NC
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Zip | 28037-0154
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Country | US
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Telephone | 704-483-5501
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Fax | 704-483-1154
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Authorized Official
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Title or Position | PARTNER
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Name | DR. JONATHAN AUSTIN
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Credential | DMD
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Telephone | 704-483-5501
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 5064
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License Number State | NC
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