Provider Demographics
NPI:1033600945
Name:WINGLER, KENNETH SHANE (DDS)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:SHANE
Last Name:WINGLER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2257 GLADYS FORK RD
Mailing Address - Street 2:
Mailing Address - City:FERGUSON
Mailing Address - State:NC
Mailing Address - Zip Code:28624-9137
Mailing Address - Country:US
Mailing Address - Phone:336-467-0561
Mailing Address - Fax:
Practice Address - Street 1:1690 RIVER ST
Practice Address - Street 2:
Practice Address - City:WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28697-7630
Practice Address - Country:US
Practice Address - Phone:336-838-9400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-25
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC110191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice