Provider Demographics
NPI:1700904620
Name:WILEY, NANCY (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:
Last Name:WILEY
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 NE 44TH ST STE 201
Mailing Address - Street 2:
Mailing Address - City:LIGHTHOUSE POINT
Mailing Address - State:FL
Mailing Address - Zip Code:33064-7373
Mailing Address - Country:US
Mailing Address - Phone:954-941-2027
Mailing Address - Fax:954-941-6027
Practice Address - Street 1:2000 NE 44TH ST STE 201
Practice Address - Street 2:
Practice Address - City:LIGHTHOUSE POINT
Practice Address - State:FL
Practice Address - Zip Code:33064-7373
Practice Address - Country:US
Practice Address - Phone:954-941-2027
Practice Address - Fax:954-941-6027
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN133501223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics