Provider Demographics
NPI:1386855336
Name:KING, WESLEY ERWIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:WESLEY
Middle Name:ERWIN
Last Name:KING
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 1:2705 CHAPEL HILL RD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-1902
Mailing Address - Country:US
Mailing Address - Phone:919-489-6581
Mailing Address - Fax:919-403-8694
Practice Address - Street 1:2705 CHAPEL HILL RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-1902
Practice Address - Country:US
Practice Address - Phone:919-489-6581
Practice Address - Fax:919-403-8694
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC62371223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8994932Medicaid