Provider Demographics
NPI:1710147707
Name:DR. MICHAEL K WIMBERLY P.C.
Entity Type:Organization
Organization Name:DR. MICHAEL K WIMBERLY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:WIMBERLY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:828-757-1188
Mailing Address - Street 1:1285 WILKESBORO BLVD
Mailing Address - Street 2:
Mailing Address - City:LENOIR
Mailing Address - State:NC
Mailing Address - Zip Code:28645-4728
Mailing Address - Country:US
Mailing Address - Phone:828-757-1188
Mailing Address - Fax:828-758-2414
Practice Address - Street 1:1285 WILKESBORO BLVD
Practice Address - Street 2:
Practice Address - City:LENOIR
Practice Address - State:NC
Practice Address - Zip Code:28645-4728
Practice Address - Country:US
Practice Address - Phone:828-757-1188
Practice Address - Fax:828-758-2414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-12
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5759122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5759OtherNC DENTAL LICENSE