Provider Demographics
NPI:1720274145
Name:WILLIAM P D WYNNE DDS PA
Entity Type:Organization
Organization Name:WILLIAM P D WYNNE DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:POINDEXTER DIXON
Authorized Official - Last Name:WYNNE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:919-851-3716
Mailing Address - Street 1:5009 WESTERN BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606
Mailing Address - Country:US
Mailing Address - Phone:919-851-3716
Mailing Address - Fax:919-851-8383
Practice Address - Street 1:5009 WESTERN BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27606
Practice Address - Country:US
Practice Address - Phone:919-851-3716
Practice Address - Fax:919-851-8383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC36301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty