Provider Demographics
NPI:1548563505
Name:WETMORE, BARBARA ANNE (DMD)
Entity Type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:ANNE
Last Name:WETMORE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 WESTPORT DR
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-3501
Mailing Address - Country:US
Mailing Address - Phone:321-427-2257
Mailing Address - Fax:321-433-1210
Practice Address - Street 1:817 WESTPORT DR
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-3501
Practice Address - Country:US
Practice Address - Phone:321-433-1141
Practice Address - Fax:321-433-1210
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-14
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN192541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice