Provider Demographics
NPI:1457535148
Name:WAYNE P. ATTKISSON,DDS, P.A.
Entity Type:Organization
Organization Name:WAYNE P. ATTKISSON,DDS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:PAGE
Authorized Official - Last Name:ATTKISSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-794-2053
Mailing Address - Street 1:402 STERLINGWORTH ST
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:NC
Mailing Address - Zip Code:27983-1726
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:402 STERLINGWORTH ST
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:NC
Practice Address - Zip Code:27983-1726
Practice Address - Country:US
Practice Address - Phone:252-794-2053
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-18
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3109122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8990288Medicaid