Provider Demographics
NPI:1073559746
Name:WETZLER, EVAN SCOTT (DDS)
Entity Type:Individual
Prefix:DR
First Name:EVAN
Middle Name:SCOTT
Last Name:WETZLER
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 1:200 VETERANS RD
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:10598-4130
Mailing Address - Country:US
Mailing Address - Phone:914-245-1550
Mailing Address - Fax:914-455-3770
Practice Address - Street 1:200 VETERANS RD
Practice Address - Street 2:
Practice Address - City:YORKTOWN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:10598-4130
Practice Address - Country:US
Practice Address - Phone:914-245-1550
Practice Address - Fax:914-455-3770
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040254-011223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics