MEDICARE: RICHARD WETHERILL III DDS PA

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
1	122300000X	Dentist

General Provider Information

NPI Number	:	1295838456
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RICHARD WETHERILL III DDS PA

Provider Business Mailing Address
First Line	:	1209 FLORAL PARKWAY
Second Line	:	STE A
City	:	WILMINGTON
State	:	NC
Zip	:	28403-6216
Country	:	US
Telephone Number	:	910-792-1085
Fax Number	:	910-792-6184

Provider Business Practice Location Address
First Line	:	1209 FLORAL PARKWAY
Second Line	:	STE A
City	:	WILMINGTON
State	:	NC
Zip	:	28403-6216
Country	:	US
Telephone Number	:	910-792-1085
Fax Number	:	910-792-6184

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RICHARD WETHERILL III
Credential	:	DDS
Telephone Number	:	910-792-1085

Provider Enumeration Date	:	09/06/2006
Last Update Date	:	08/22/2020

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