Provider Demographics
NPI:1497159164
Name:WESLEY DUFFEL DDS FAMILY DENTISTRY PLLC
Entity Type:Organization
Organization Name:WESLEY DUFFEL DDS FAMILY DENTISTRY PLLC
Other - Org Name:DUFFEL DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:AARON
Authorized Official - Last Name:DUFFEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-577-6999
Mailing Address - Street 1:501 S MUSTANG RD
Mailing Address - Street 2:SUITE K
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-6849
Mailing Address - Country:US
Mailing Address - Phone:405-577-6999
Mailing Address - Fax:
Practice Address - Street 1:501 S MUSTANG RD
Practice Address - Street 2:SUITE K
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-6849
Practice Address - Country:US
Practice Address - Phone:405-577-6999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-09
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6102122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty