Provider Demographics
NPI:1003974072
Name:HEALEY, KENT WADDELL (DDS)
Entity type:Individual
Prefix:DR
First Name:KENT
Middle Name:WADDELL
Last Name:HEALEY
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 1:6 SWEETBRIAR LN
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-9011
Mailing Address - Country:US
Mailing Address - Phone:919-408-0888
Mailing Address - Fax:
Practice Address - Street 1:920 MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-2619
Practice Address - Country:US
Practice Address - Phone:919-942-0651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC30751223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics