Provider Demographics
NPI:1508344961
Name:FICHERA, WESLEY (DDS)
Entity Type:Individual
Prefix:DR
First Name:WESLEY
Middle Name:
Last Name:FICHERA
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 1:2212 SUMMIT DR
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-1060
Mailing Address - Country:US
Mailing Address - Phone:817-992-5093
Mailing Address - Fax:
Practice Address - Street 1:2212 SUMMIT DR
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-1060
Practice Address - Country:US
Practice Address - Phone:817-992-5093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-29
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34484122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist