Provider Demographics
NPI:1700983384
Name:WESLEY, BRIGETTE RENEE (DDS)
Entity Type:Individual
Prefix:MS
First Name:BRIGETTE
Middle Name:RENEE
Last Name:WESLEY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5318 NC HIGHWAY 55
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-9659
Mailing Address - Country:US
Mailing Address - Phone:919-484-0880
Mailing Address - Fax:
Practice Address - Street 1:5318 NC HIGHWAY 55
Practice Address - Street 2:SUITE 101
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-9659
Practice Address - Country:US
Practice Address - Phone:919-484-0880
Practice Address - Fax:919-484-0888
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC82461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice