Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | DS025939L | PA |
NPI | 1336259456 |
---|---|
Provider Name | Dr. David William Wedell |
First Address | Willow Grove, PA 19090 |
Second Address | Willow Grove, PA 19090 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T72277 | (02) |