Provider Demographics
NPI:1467833475
Name:FRAME, WESLEY MICHAEL
Entity Type:Individual
Prefix:
First Name:WESLEY
Middle Name:MICHAEL
Last Name:FRAME
Suffix:
Gender:M
Credentials:
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 35
Mailing Address - Street 2:202 N MAIN ST
Mailing Address - City:LYNN
Mailing Address - State:IN
Mailing Address - Zip Code:47355-0035
Mailing Address - Country:US
Mailing Address - Phone:765-874-2571
Mailing Address - Fax:765-874-1400
Practice Address - Street 1:202 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:IN
Practice Address - Zip Code:47355-0035
Practice Address - Country:US
Practice Address - Phone:765-874-2571
Practice Address - Fax:765-874-1400
Is Sole Proprietor?:No
Enumeration Date:2015-06-16
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12012288A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice