Provider Demographics
NPI:1023272242
Name:WESSELL, MICHAEL D (DDS)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:D
Last Name:WESSELL
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 1:172 CHRISTY ST
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:WI
Mailing Address - Zip Code:54406-9389
Mailing Address - Country:US
Mailing Address - Phone:715-824-3300
Mailing Address - Fax:
Practice Address - Street 1:172 CHRISTY ST
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:WI
Practice Address - Zip Code:54406-9389
Practice Address - Country:US
Practice Address - Phone:715-824-3300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-16
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3194GWI1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33686900Medicaid