Provider Demographics
NPI:1093421232
Name:ROSS M WEZMAR, DDS, PC
Entity Type:Organization
Organization Name:ROSS M WEZMAR, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:M
Authorized Official - Last Name:WEZMAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-575-2358
Mailing Address - Street 1:1814 W TILGHMAN ST
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-4116
Mailing Address - Country:US
Mailing Address - Phone:484-214-7700
Mailing Address - Fax:
Practice Address - Street 1:1814 W TILGHMAN ST
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-4116
Practice Address - Country:US
Practice Address - Phone:484-214-7700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental