Provider Demographics
NPI:1225535388
Name:WESOLEK, RHONDA LEWIS (RDH)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:LEWIS
Last Name:WESOLEK
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:RHONDA
Other - Middle Name:SUE
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:107 ABERDEEN AVE
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:AL
Mailing Address - Zip Code:36330-2339
Mailing Address - Country:US
Mailing Address - Phone:334-470-7916
Mailing Address - Fax:
Practice Address - Street 1:BLDG 4405, INNKEEPER STREET
Practice Address - Street 2:
Practice Address - City:FORT RUCKER
Practice Address - State:AL
Practice Address - Zip Code:36362
Practice Address - Country:US
Practice Address - Phone:334-255-3393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-06
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10467124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist