Provider Demographics
NPI:1770780645
Name:EASLEY, WAYLAND A (DDS)
Entity type:Individual
Prefix:DR
First Name:WAYLAND
Middle Name:A
Last Name:EASLEY
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 1:230 AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02889
Mailing Address - Country:US
Mailing Address - Phone:401-732-4117
Mailing Address - Fax:401-352-0807
Practice Address - Street 1:230 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02889
Practice Address - Country:US
Practice Address - Phone:401-732-4117
Practice Address - Fax:401-352-0807
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA21302122300000X
NY051644122300000X
MA0223000 MASSHEALTH1223S0112X
MA0223000 DORAL DENTAL1223S0112X
PAAGHDREXEL OMS1223S0112X
MA2130220207L00000X
RIDAPA02663207L00000X
RIDEN02883122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0223000Medicaid
MA0223000OtherDORAL : BMC HEALTH PLAN,NEIGHBORHOOD(MA),NETWORK HEALTH, SR. WHOLE HEALTH
RIWE57613Medicaid