Provider Demographics
NPI:1912062134
Name:WIIST, STEPHEN WILLIAM (DDS)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:WILLIAM
Last Name:WIIST
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 1:3434 KILDAIRE FARM ROAD
Mailing Address - Street 2:SUITE 138
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518
Mailing Address - Country:US
Mailing Address - Phone:919-362-3862
Mailing Address - Fax:919-362-6385
Practice Address - Street 1:3434 KILDAIRE FARM ROAD
Practice Address - Street 2:SUITE 138
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518
Practice Address - Country:US
Practice Address - Phone:919-362-3862
Practice Address - Fax:919-362-6385
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS035250122300000X
NC8658122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist