Provider Demographics
NPI:1932226354
Name:LEY, WAYNE ALLEN (DDS)
Entity type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:ALLEN
Last Name:LEY
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:P.O. BOX 955
Mailing Address - Street 2:
Mailing Address - City:NEEDVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77461-0955
Mailing Address - Country:US
Mailing Address - Phone:979-793-3366
Mailing Address - Fax:
Practice Address - Street 1:8717 MAIN ST
Practice Address - Street 2:
Practice Address - City:NEEDVILLE
Practice Address - State:TX
Practice Address - Zip Code:77461-8138
Practice Address - Country:US
Practice Address - Phone:979-793-3366
Practice Address - Fax:979-793-7901
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0083768 01Medicaid