Healthcare Provider Details

I. General information

NPI: 1841339249
Provider Name (Legal Business Name): DENN B. WESSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1307 I ST
MODESTO CA
95354-0913
US

IV. Provider business mailing address

1405 LOUISE AVE
MODESTO CA
95350-5722
US

V. Phone/Fax

Practice location:
  • Phone: 209-524-6111
  • Fax: 209-524-6177
Mailing address:
  • Phone: 209-526-3261
  • Fax: 209-526-3261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHA1348
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: