Provider Demographics
NPI:1770147472
Name:MCWATTERS, WESLEY TYLER (DDS)
Entity type:Individual
Prefix:
First Name:WESLEY
Middle Name:TYLER
Last Name:MCWATTERS
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 1:2724 PHILLIPS AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28208-7030
Mailing Address - Country:US
Mailing Address - Phone:304-881-3988
Mailing Address - Fax:
Practice Address - Street 1:2719 COLTSGATE RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-3502
Practice Address - Country:US
Practice Address - Phone:704-366-8707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-28
Last Update Date:2024-01-03
Deactivation Date:2019-05-12
Deactivation Code:
Reactivation Date:2019-05-22
Provider Licenses
StateLicense IDTaxonomies
NC131221223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery