Provider Demographics
NPI:1033281209
Name:WESSEL, AUDRA ANN (DDS)
Entity Type:Individual
Prefix:DR
First Name:AUDRA
Middle Name:ANN
Last Name:WESSEL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14072 ZINRAN AVE
Mailing Address - Street 2:
Mailing Address - City:SAVAGE
Mailing Address - State:MN
Mailing Address - Zip Code:55378-2158
Mailing Address - Country:US
Mailing Address - Phone:952-445-6494
Mailing Address - Fax:952-884-0188
Practice Address - Street 1:8910 PENN AVE S
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55431-2025
Practice Address - Country:US
Practice Address - Phone:952-881-0504
Practice Address - Fax:952-884-0188
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND109161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice