Provider Demographics
NPI:1013588896
Name:MIRAY WESSA DMD, PC ST MARY DENTAL CARE
Entity Type:Organization
Organization Name:MIRAY WESSA DMD, PC ST MARY DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MIRAY
Authorized Official - Middle Name:
Authorized Official - Last Name:WESSA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-394-3001
Mailing Address - Street 1:38 ROUTE 134
Mailing Address - Street 2:
Mailing Address - City:SOUTH DENNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02660-3818
Mailing Address - Country:US
Mailing Address - Phone:508-394-3001
Mailing Address - Fax:508-760-4916
Practice Address - Street 1:38 ROUTE 134
Practice Address - Street 2:
Practice Address - City:SOUTH DENNIS
Practice Address - State:MA
Practice Address - Zip Code:02660-3818
Practice Address - Country:US
Practice Address - Phone:508-394-3001
Practice Address - Fax:508-760-4916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-02
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty