Provider Demographics
NPI:1154544385
Name:HESTER, WAYNE (DMD)
Entity type:Individual
Prefix:
First Name:WAYNE
Middle Name:
Last Name:HESTER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3229 N OAK STREET EXT
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31605-6472
Mailing Address - Country:US
Mailing Address - Phone:229-245-1800
Mailing Address - Fax:229-245-0225
Practice Address - Street 1:3229 N OAK STREET EXT
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31605-6472
Practice Address - Country:US
Practice Address - Phone:229-245-1800
Practice Address - Fax:229-245-0225
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA93511223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics