Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 61259 | CA |
NPI | 1063612992 |
---|---|
Provider Name | Dr. Wes Richardson Cardall |
First Address | Bakersfield, CA 93312-6391 |
Second Address | Bakersfield, CA 93312-6391 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2007 |
Last Update Date | 01/07/2013 |