Provider Demographics
NPI:1336156025
Name:SMITH, WESLEY BERNARD (DDS)
Entity type:Individual
Prefix:DR
First Name:WESLEY
Middle Name:BERNARD
Last Name:SMITH
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 1:2077 NEW HOPE CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27523
Mailing Address - Country:US
Mailing Address - Phone:919-303-3313
Mailing Address - Fax:
Practice Address - Street 1:130 PRESTON EXECUTIVE DR
Practice Address - Street 2:STE 203
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513
Practice Address - Country:US
Practice Address - Phone:919-467-9313
Practice Address - Fax:919-467-5015
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC6471122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
97964OtherBCBS
97964OtherBCBS