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NPI Code Detail

MEDICARE: DR. MICHAEL KEITH WIMBERLY DDS

MEDICARE: DR. MICHAEL KEITH WIMBERLY DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist5759NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1073730107
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MICHAEL KEITH WIMBERLY DDS
Provider Business Mailing Address
First Line : 1183 FAIRGROVE CHURCH RD SE
Second Line :
City : CONOVER
State : NC
Zip : 28613-9090
Country : US
Telephone Number : 828-466-2488
Fax Number : 828-466-2450
Provider Business Practice Location Address
First Line : 1183 FAIRGROVE CHURCH RD SE
Second Line :
City : CONOVER
State : NC
Zip : 28613-9090
Country : US
Telephone Number : 828-466-2488
Fax Number : 828-466-2450
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/19/2007
Last Update Date : 07/09/2007

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