Healthcare Provider Details

I. General information

NPI: 1497317705
Provider Name (Legal Business Name): ALBERT J WESLEY D D S PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2019
Last Update Date: 07/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 OLDE TOWNE ROAD #81907
ROCHESTER MI
48308
US

IV. Provider business mailing address

511 OLDE TOWNE RD UNIT 81907
ROCHESTER MI
48308-7769
US

V. Phone/Fax

Practice location:
  • Phone: 248-270-5358
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ALBERT WESLEY
Title or Position: OWNER
Credential:
Phone: 248-270-5358