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 |