Basic Information
| Provider Information | |||||||||
| NPI: | 1053691725 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TODD E WESSLEN DDS MS INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 426 S GARDEN ST | ||||||||
| Address2: | |||||||||
| City: | VISALIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932772810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5597325658 | ||||||||
| FaxNumber: | 5597321958 | ||||||||
| Practice Location | |||||||||
| Address1: | 426 S GARDEN ST | ||||||||
| Address2: | |||||||||
| City: | VISALIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932772810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5597325658 | ||||||||
| FaxNumber: | 5597321958 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/25/2011 | ||||||||
| LastUpdateDate: | 12/11/2011 | ||||||||
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| AuthorizedOfficialLastName: | WESSLEN | ||||||||
| AuthorizedOfficialFirstName: | TODD | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5597325658 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DDS, MS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223X0400X | 58491 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Dental Providers | Dentist | Orthodontics and Dentofacial Orthopedics |
No ID Information.