Provider Demographics
NPI:1497821110
Name:BOOKER, WAYNE ERNEST (DDS)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:ERNEST
Last Name:BOOKER
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 1:6632 GEORGE WASHINGTON MEMORIAL HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:23692-4801
Mailing Address - Country:US
Mailing Address - Phone:757-898-5468
Mailing Address - Fax:757-898-3035
Practice Address - Street 1:6632 GEORGE WASHINGTON MEMORIAL HIGHWAY
Practice Address - Street 2:
Practice Address - City:YORKTOWN
Practice Address - State:VA
Practice Address - Zip Code:23692-4801
Practice Address - Country:US
Practice Address - Phone:757-898-5468
Practice Address - Fax:757-898-3035
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401006044122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist