Provider Demographics
NPI:1750047593
Name:MICHAEL L WING DDS PA
Entity Type:Organization
Organization Name:MICHAEL L WING DDS PA
Other - Org Name:BIRKDALE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:WING
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:704-997-8280
Mailing Address - Street 1:8712 LINDHOLM DR STE 200
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-1888
Mailing Address - Country:US
Mailing Address - Phone:704-997-8280
Mailing Address - Fax:704-288-3643
Practice Address - Street 1:8712 LINDHOLM DR STE 200
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-1888
Practice Address - Country:US
Practice Address - Phone:704-997-8280
Practice Address - Fax:704-288-3643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-16
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental