| NPI | 1295910719 |
|---|---|
| Former Legal Business Name | T. WAYNE WILSON AND PHILLIP D. BEAVER, DDS, PA |
| Entity Type | Organization |
| Authorized Contact | THOMAS WAYNE WILSON President 704-636-5802 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: NC 4132) |
| Enumeration Date | 2008-01-03 |
| Last Update Date | 2015-09-30 |