Provider Demographics
NPI:1437386075
Name:DUFFEL, WESLEY AARON (DDS)
Entity Type:Individual
Prefix:DR
First Name:WESLEY
Middle Name:AARON
Last Name:DUFFEL
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 1:500 N EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-5851
Mailing Address - Country:US
Mailing Address - Phone:405-912-3300
Mailing Address - Fax:405-912-2278
Practice Address - Street 1:500 N EASTERN AVE
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-5851
Practice Address - Country:US
Practice Address - Phone:405-912-3300
Practice Address - Fax:405-912-2278
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-22
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6102122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist