Provider Demographics
NPI:1881733368
Name:WEDELL, GEORGE BURLEIGH (DDS)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:BURLEIGH
Last Name:WEDELL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3910 85TH ST
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53142-4927
Mailing Address - Country:US
Mailing Address - Phone:262-694-6800
Mailing Address - Fax:262-694-6341
Practice Address - Street 1:3910 85TH ST
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-4927
Practice Address - Country:US
Practice Address - Phone:262-694-6800
Practice Address - Fax:262-694-6341
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI50009600151223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics