Provider Demographics
NPI:1336259456
Name:WEDELL, DAVID WILLIAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:WILLIAM
Last Name:WEDELL
Suffix:
Gender:M
Credentials:DDS
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Mailing Address - Street 1:608 N EASTON RD
Mailing Address - Street 2:SUITE A DAVID W WEDELL DDS LLC
Mailing Address - City:WILLOW GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19090
Mailing Address - Country:US
Mailing Address - Phone:215-784-9711
Mailing Address - Fax:215-784-9713
Practice Address - Street 1:608 N EASTON RD
Practice Address - Street 2:SUITE A DAVID W WEDELL DDS LLC
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:19090
Practice Address - Country:US
Practice Address - Phone:215-784-9711
Practice Address - Fax:215-784-9713
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PADS025939L204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA137456TLHMedicare ID - Type Unspecified
T72277Medicare UPIN