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General NPI Number Information
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NPI Number | 1457119190
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Entity Type | Individual
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Provider Name | ANNIKA KRISTIN WESSEL DMD
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Gender | Female
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Dates
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Enumeration Date | 03/07/2024
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Last Update Date | 03/07/2024
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Provider Practice Location Address
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Address Line | 20 N MOUNTAIN BLVD
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City | MOUNTAIN TOP
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State | PA
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Zip | 18707-1117
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Country | US
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Telephone | 570-474-0420
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Fax |
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Provider Business Mailing Address
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Address Line | 45 SYCAMORE DR
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City | DRUMS
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State | PA
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Zip | 18222-2049
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Country | US
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Telephone | 570-582-6913
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DS043364
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License Number State | PA
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