Provider Demographics
NPI:1275071557
Name:GASS, WESLEY ROBERT (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:WESLEY
Middle Name:ROBERT
Last Name:GASS
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3818 WINDSOR TRL
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30506-2246
Mailing Address - Country:US
Mailing Address - Phone:678-296-5229
Mailing Address - Fax:
Practice Address - Street 1:3818 WINDSOR TRL
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30506-2246
Practice Address - Country:US
Practice Address - Phone:678-296-5229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-07
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32668122300000X
GADN0152111223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
No122300000XDental ProvidersDentist