Provider Demographics
NPI:1689792160
Name:WECHTLER, BRUCE MATTHEW (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:MATTHEW
Last Name:WECHTLER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 SOUTH 3RD STREET
Mailing Address - Street 2:
Mailing Address - City:COOPERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18036
Mailing Address - Country:US
Mailing Address - Phone:610-282-4900
Mailing Address - Fax:610-282-1665
Practice Address - Street 1:202 SOUTH 3RD STREET
Practice Address - Street 2:
Practice Address - City:COOPERSBURG
Practice Address - State:PA
Practice Address - Zip Code:18036
Practice Address - Country:US
Practice Address - Phone:610-282-4900
Practice Address - Fax:610-282-1665
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS019313L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice