Provider Demographics
NPI:1295838456
Name:RICHARD WETHERILL III DDS PA
Entity Type:Organization
Organization Name:RICHARD WETHERILL III DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:WETHERILL
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:910-792-1085
Mailing Address - Street 1:1209 FLORAL PARKWAY
Mailing Address - Street 2:STE A
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-6216
Mailing Address - Country:US
Mailing Address - Phone:910-792-1085
Mailing Address - Fax:910-792-6184
Practice Address - Street 1:1209 FLORAL PARKWAY
Practice Address - Street 2:STE A
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6216
Practice Address - Country:US
Practice Address - Phone:910-792-1085
Practice Address - Fax:910-792-6184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty