Provider Demographics
NPI:1407887698
Name:WILLOUGHBY, WENDY DEE (DDS)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:DEE
Last Name:WILLOUGHBY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:192 E CHESTNUT ST STE B
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-2387
Mailing Address - Country:US
Mailing Address - Phone:828-255-0936
Mailing Address - Fax:
Practice Address - Street 1:192 E CHESTNUT ST STE B
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-2387
Practice Address - Country:US
Practice Address - Phone:828-255-0936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC56511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8999381Medicaid
NC8999381Medicaid