Provider Demographics
NPI:1144746728
Name:HERBERT S WILMER DDS PA
Entity Type:Organization
Organization Name:HERBERT S WILMER DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:AUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:704-483-5501
Mailing Address - Street 1:PO BOX 154
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:NC
Mailing Address - Zip Code:28037-0154
Mailing Address - Country:US
Mailing Address - Phone:704-483-5501
Mailing Address - Fax:704-483-1154
Practice Address - Street 1:3718 N NC 16 BUSINESS HWY
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:NC
Practice Address - Zip Code:28037-8179
Practice Address - Country:US
Practice Address - Phone:704-483-5501
Practice Address - Fax:704-483-5501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-16
Last Update Date:2017-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5064261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1508217597OtherNPPES
NC1720145360OtherNPPES