Provider Demographics
NPI:1760641260
Name:WINGO, WILLIAM LESLIE JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:LESLIE
Last Name:WINGO
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18100 HIGHWAY 104
Mailing Address - Street 2:
Mailing Address - City:ROBERTSDALE
Mailing Address - State:AL
Mailing Address - Zip Code:36567-8734
Mailing Address - Country:US
Mailing Address - Phone:251-947-5940
Mailing Address - Fax:251-947-5942
Practice Address - Street 1:18100 HIGHWAY 104
Practice Address - Street 2:
Practice Address - City:ROBERTSDALE
Practice Address - State:AL
Practice Address - Zip Code:36567-8734
Practice Address - Country:US
Practice Address - Phone:251-947-5940
Practice Address - Fax:251-947-5942
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL32921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice