Provider Demographics
NPI:1073770855
Name:WESLEY, ALBERT (DDS)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:
Last Name:WESLEY
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 1:3753 ORION RD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48363-3032
Mailing Address - Country:US
Mailing Address - Phone:248-672-8118
Mailing Address - Fax:248-601-4462
Practice Address - Street 1:3753 ORION RD
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:MI
Practice Address - Zip Code:48363-3032
Practice Address - Country:US
Practice Address - Phone:248-672-8118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-20
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0512951223G0001X
MI29010152951223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
No1223G0001XDental ProvidersDentistGeneral Practice