Provider Demographics
NPI:1447288816
Name:WESSELS, STEPHEN J (DMD, PA)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:J
Last Name:WESSELS
Suffix:
Gender:M
Credentials:DMD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1509 RIVER ST
Mailing Address - Street 2:
Mailing Address - City:WILKESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28697-7391
Mailing Address - Country:US
Mailing Address - Phone:336-838-4119
Mailing Address - Fax:336-838-1746
Practice Address - Street 1:1509 RIVER ST
Practice Address - Street 2:
Practice Address - City:WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28697-7391
Practice Address - Country:US
Practice Address - Phone:336-838-4119
Practice Address - Fax:336-838-1746
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5648122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist