Provider Demographics
NPI:1023192689
Name:LASATER, WESLEY ALLEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:WESLEY
Middle Name:ALLEN
Last Name:LASATER
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 1:1804 HIGHWAY 16 SOUTH
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:TX
Mailing Address - Zip Code:76450-4608
Mailing Address - Country:US
Mailing Address - Phone:940-549-4161
Mailing Address - Fax:940-549-4627
Practice Address - Street 1:1804 HIGHWAY 16 SOUTH
Practice Address - Street 2:
Practice Address - City:GRAHAM
Practice Address - State:TX
Practice Address - Zip Code:76450-4608
Practice Address - Country:US
Practice Address - Phone:940-549-4161
Practice Address - Fax:940-549-4161
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX92281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice