Provider Demographics
NPI:1851425797
Name:WETMORE, MARK KEVIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:KEVIN
Last Name:WETMORE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 BERKSHIRE CT
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-1224
Mailing Address - Country:US
Mailing Address - Phone:610-374-4524
Mailing Address - Fax:610-374-2946
Practice Address - Street 1:40 BERKSHIRE CT
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-1224
Practice Address - Country:US
Practice Address - Phone:610-374-4524
Practice Address - Fax:610-374-2946
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-025596L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice