Provider Demographics
NPI:1053495754
Name:WEDAM, ALBERT HAMILTON (DMD)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:HAMILTON
Last Name:WEDAM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2972 SOUTH SIXTH STREET
Mailing Address - Street 2:SUITE C
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97603
Mailing Address - Country:US
Mailing Address - Phone:541-884-5474
Mailing Address - Fax:541-882-1461
Practice Address - Street 1:2972 SOUTH SIXTH STREET
Practice Address - Street 2:SUITE C
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97603
Practice Address - Country:US
Practice Address - Phone:541-884-5474
Practice Address - Fax:541-882-1461
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6117122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist