Healthcare Provider Details

I. General information

NPI: 1275862484
Provider Name (Legal Business Name): JOHN HENRY WESSEL III DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2009
Last Update Date: 12/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 BERGEN ST ROOM B-854
NEWARK NJ
07103-2495
US

IV. Provider business mailing address

800 JEFFERSON ST APT 4E
HOBOKEN NJ
07030-2167
US

V. Phone/Fax

Practice location:
  • Phone: 973-972-5026
  • Fax:
Mailing address:
  • Phone: 248-343-5321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number22DR02206
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: