Provider Demographics
NPI:1275948416
Name:WEDDE, CHRYSTAL SACHEEN (RDH)
Entity Type:Individual
Prefix:
First Name:CHRYSTAL
Middle Name:SACHEEN
Last Name:WEDDE
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 128
Mailing Address - Street 2:
Mailing Address - City:LAC DU FLAMBEAU
Mailing Address - State:WI
Mailing Address - Zip Code:54538-0128
Mailing Address - Country:US
Mailing Address - Phone:715-588-4269
Mailing Address - Fax:715-588-2484
Practice Address - Street 1:128 OLD ABE RD
Practice Address - Street 2:
Practice Address - City:LAC DU FLAMBEAU
Practice Address - State:WI
Practice Address - Zip Code:54538-9386
Practice Address - Country:US
Practice Address - Phone:715-588-4269
Practice Address - Fax:715-588-2484
Is Sole Proprietor?:No
Enumeration Date:2014-06-26
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11577-16124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist