Provider Demographics
NPI:1033213780
Name:JANSSEN, WESLEY D (DDS)
Entity Type:Individual
Prefix:
First Name:WESLEY
Middle Name:D
Last Name:JANSSEN
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:PO BOX 336
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NE
Mailing Address - Zip Code:68446-0336
Mailing Address - Country:US
Mailing Address - Phone:402-269-2535
Mailing Address - Fax:402-269-2535
Practice Address - Street 1:557 MOHAWK ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NE
Practice Address - Zip Code:68446-0336
Practice Address - Country:US
Practice Address - Phone:402-269-2535
Practice Address - Fax:402-269-2535
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE47451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE05377OtherBLUE CROSS
NE47061931400Medicaid