Provider Demographics
NPI:1245675131
Name:ZACHARY J. WESLEY DDS PLC
Entity type:Organization
Organization Name:ZACHARY J. WESLEY DDS PLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ZACHARY
Authorized Official - Middle Name:J
Authorized Official - Last Name:WESLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:615-377-0111
Mailing Address - Street 1:761 OLD HICKORY BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-4519
Mailing Address - Country:US
Mailing Address - Phone:615-377-0111
Mailing Address - Fax:615-371-8089
Practice Address - Street 1:761 OLD HICKORY BLVD STE 100
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-4519
Practice Address - Country:US
Practice Address - Phone:615-377-0111
Practice Address - Fax:615-371-8089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-06
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN82241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty