Provider Demographics
NPI:1316053176
Name:WETHERILL, RICHARD III (DDS)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:WETHERILL
Suffix:III
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 1:1209 FLORAL PKWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-6216
Mailing Address - Country:US
Mailing Address - Phone:910-792-1085
Mailing Address - Fax:910-792-6184
Practice Address - Street 1:1209 FLORAL PKWY
Practice Address - Street 2:SUITE A
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6216
Practice Address - Country:US
Practice Address - Phone:910-792-1085
Practice Address - Fax:910-792-6184
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6892122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist