Healthcare Provider Details

I. General information

NPI: 1932126661
Provider Name (Legal Business Name): BRADLEY DEAN WESSELS D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 11/30/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 MAIN ST
GREEN BAY WI
54301-5115
US

IV. Provider business mailing address

N9650 DARBOY DR
APPLETON WI
54915-9356
US

V. Phone/Fax

Practice location:
  • Phone: 920-431-0345
  • Fax:
Mailing address:
  • Phone: 920-830-0490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2729
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: