Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 58491 | CA |
NPI | 1063792737 |
---|---|
Provider Name | Dr. Todd Wesslen |
First Address | Visalia, CA 93277-2810 |
Second Address | Visalia, CA 93277-2810 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2011 |
Last Update Date | 11/12/2011 |