Provider Demographics
NPI:1952608291
Name:WASSEL, TED (DDS)
Entity Type:Individual
Prefix:
First Name:TED
Middle Name:
Last Name:WASSEL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1030 LA BONITA DR
Mailing Address - Street 2:SUITE 322
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-5291
Mailing Address - Country:US
Mailing Address - Phone:760-744-1919
Mailing Address - Fax:760-744-4625
Practice Address - Street 1:1030 LA BONITA DR
Practice Address - Street 2:SUITE 322
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-5291
Practice Address - Country:US
Practice Address - Phone:760-744-1919
Practice Address - Fax:760-744-4625
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-23
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA400401223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery