Provider Demographics
NPI:1942542246
Name:DR. ROSS WEZMAR DDS PC
Entity Type:Organization
Organization Name:DR. ROSS WEZMAR DDS PC
Other - Org Name:AFFILIATED PEDIATRIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:M
Authorized Official - Last Name:WEZMAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS PC
Authorized Official - Phone:570-822-4181
Mailing Address - Street 1:900 SCHECHTER DR
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702-6781
Mailing Address - Country:US
Mailing Address - Phone:570-822-4181
Mailing Address - Fax:
Practice Address - Street 1:900 SCHECHTER DR
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-6781
Practice Address - Country:US
Practice Address - Phone:570-822-4181
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-25
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS017699L305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service