Provider Demographics
NPI:1629244637
Name:WETZEL, JAMES LEWIS JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:LEWIS
Last Name:WETZEL
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:932 S DAVID ST
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-3738
Mailing Address - Country:US
Mailing Address - Phone:307-237-8419
Mailing Address - Fax:307-234-4912
Practice Address - Street 1:932 S DAVID ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-3738
Practice Address - Country:US
Practice Address - Phone:307-237-8419
Practice Address - Fax:307-234-4912
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-30
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY5461223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY123677600Medicaid