Provider Demographics
NPI:1891718953
Name:WESSEL, MATTHEW E (DDS)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:E
Last Name:WESSEL
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 1:10615 W THUNDERBIRD BLVD
Mailing Address - Street 2:
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85351-3033
Mailing Address - Country:US
Mailing Address - Phone:623-972-2156
Mailing Address - Fax:623-972-6952
Practice Address - Street 1:10615 W THUNDERBIRD BLVD
Practice Address - Street 2:B-500
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3033
Practice Address - Country:US
Practice Address - Phone:623-972-2156
Practice Address - Fax:623-972-6952
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ48941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice