Healthcare Provider Details

I. General information

NPI: 1043252422
Provider Name (Legal Business Name): DR WECHTLER & ASSOC , INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 08/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 S 3RD ST
COOPERSBURG PA
18036
US

IV. Provider business mailing address

202 S 3RD ST
COOPERSBURG PA
18036
US

V. Phone/Fax

Practice location:
  • Phone: 610-282-4900
  • Fax: 610-282-1665
Mailing address:
  • Phone: 610-282-4900
  • Fax: 610-282-1665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS 036499
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS 019313
License Number StatePA

VIII. Authorized Official

Name: DR. BRUCE MATTHEW WECHTLER
Title or Position: OWNER
Credential: DMD
Phone: 610-282-4900