Provider Demographics
NPI:1174638498
Name:WEDDLE, DEAN T (DDS)
Entity Type:Individual
Prefix:MR
First Name:DEAN
Middle Name:T
Last Name:WEDDLE
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 1:106 WEST MAIN
Mailing Address - Street 2:#212
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730-5635
Mailing Address - Country:US
Mailing Address - Phone:870-863-8161
Mailing Address - Fax:870-863-8356
Practice Address - Street 1:106 WEST MAIN
Practice Address - Street 2:#212
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-5635
Practice Address - Country:US
Practice Address - Phone:870-863-8161
Practice Address - Fax:870-863-8356
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1967122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist