Provider Demographics
NPI:1285652610
Name:WETREICH, GARY SCOTT (DDS)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:SCOTT
Last Name:WETREICH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1 WASHINGTON STREET
Mailing Address - Street 2:SUITE 204
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-1706
Mailing Address - Country:US
Mailing Address - Phone:781-237-0871
Mailing Address - Fax:781-237-0871
Practice Address - Street 1:1 WASHINGTON STREET
Practice Address - Street 2:SUITE 204
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-1706
Practice Address - Country:US
Practice Address - Phone:781-237-0871
Practice Address - Fax:781-237-0871
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA148651223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics