Wesley Tyler McWatters, DDS

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

13122 Issued in NC

Practice address

2719 Coltsgate Rd
Charlotte, NC 28211-3502

Phone

(704) 366-8707

NPI assigned

Apr 28, 2019

Reactivated

May 22, 2019

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective May 7, 2024 through May 7, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• South Park Oral Surgery

  • Oral and Maxillofacial Surgery (Dentist)
  • Charlotte, NC
  • NPI 1003502519
  NPD
• University of Frida

  • Dentist
  • Gainesville, FL
  • NPI 1629429204
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1556409600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704240000000",
    "number": "1770147472",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2724 PHILLIPS AVE",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282087030",
            "telephone_number": "304-881-3988"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2719 COLTSGATE RD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282113502",
            "telephone_number": "704-366-8707"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCWATTERS",
        "first_name": "WESLEY",
        "middle_name": "TYLER",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-04-28",
        "last_updated": "2024-01-03",
        "certification_date": "2024-01-03",
        "deactivation_date": "2019-05-12",
        "reactivation_date": "2019-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NC",
            "license": "13122",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carrie Anne McShane, M.D.
• Claudine McShane
• Christina McShea, MD
• Kelly Anne McStravock
• Breana Lee McSwain
• Meiosha McWhorter
• Micah Lynn McWhorter
• Leslie Patricia McWilliam-Duffy, RN, FMHC, RYT 200
• McWilliams Center for Counseling, Inc.
• McWilliams Center for Counseling, Inc.

• Oral and Maxillofacial Surgery (Dentist) in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Oral and Maxillofacial Surgery (Dentist) in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.