Provider Demographics
NPI:1679095806
Name:WASLESKE, BEN PAUL
Entity Type:Individual
Prefix:
First Name:BEN
Middle Name:PAUL
Last Name:WASLESKE
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:BEN
Other - Middle Name:PAUL
Other - Last Name:WASLESKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:7207 RIVER TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:WI
Mailing Address - Zip Code:54476-7710
Mailing Address - Country:US
Mailing Address - Phone:715-581-2368
Mailing Address - Fax:
Practice Address - Street 1:7207 RIVER TRAIL DR
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:WI
Practice Address - Zip Code:54476-7710
Practice Address - Country:US
Practice Address - Phone:715-581-2368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI100161315122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist