Provider Demographics
NPI:1639290059
Name:WETMORE, ANN O'KELLEY (RDH)
Entity Type:Individual
Prefix:MRS
First Name:ANN
Middle Name:O'KELLEY
Last Name:WETMORE
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 N CHANTSONG CIR
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77382-2609
Mailing Address - Country:US
Mailing Address - Phone:281-296-7104
Mailing Address - Fax:
Practice Address - Street 1:6516 M.D. ANDERSON BLVD. STE. 1.085
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030
Practice Address - Country:US
Practice Address - Phone:713-500-4394
Practice Address - Fax:713-500-0410
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12522124Q00000X
CA10247124Q00000X
ORH1235124Q00000X
WADH00001974124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist