1285648774 NPI number — DR. MILLARD WINSTON WESTER III DDS

Table of content: DR. MILLARD WINSTON WESTER III DDS (NPI 1285648774)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285648774 NPI number — DR. MILLARD WINSTON WESTER III DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WESTER
Provider First Name:
MILLARD
Provider Middle Name:
WINSTON
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
III
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285648774
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
511 RUIN CREEK RD
Provider Second Line Business Mailing Address:
SUITE 204
Provider Business Mailing Address City Name:
HENDERSON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27536-5919
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-492-1115
Provider Business Mailing Address Fax Number:
252-492-8682

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
511 RUIN CREEK RD
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
HENDERSON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27536-5919
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-492-1115
Provider Business Practice Location Address Fax Number:
252-492-8682
Provider Enumeration Date:
07/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  4823 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8999147 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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