Provider Demographics
NPI:1255825790
Name:DENT, WESLEY ADDISON (DMD)
Entity type:Individual
Prefix:DR
First Name:WESLEY
Middle Name:ADDISON
Last Name:DENT
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 1:1508 THURSO RD
Mailing Address - Street 2:
Mailing Address - City:LYNN HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:32444-8336
Mailing Address - Country:US
Mailing Address - Phone:228-238-3205
Mailing Address - Fax:
Practice Address - Street 1:528 W BALDWIN RD UNIT B
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-3313
Practice Address - Country:US
Practice Address - Phone:850-215-0128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-18
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN235051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice