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General NPI Number Information
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NPI Number | 1619507779
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Entity Type | Organization
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Legal Business Name | GERARD WASSELLE DMD LLC
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Dates
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Enumeration Date | 01/17/2020
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Last Update Date | 11/17/2020
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Provider Practice Location Address
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Address Line | 2480 E COMMERCIAL BLVD, SUITE 2
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City | FT LAUDERDALE
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State | FL
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Zip | 33308-3330
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Country | US
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Telephone | 954-928-1666
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Fax | 954-928-1895
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Provider Business Mailing Address
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Address Line | 2440 E COMMERCIAL BLVD
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City | FT LAUDERDALE
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State | FL
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Zip | 33308-4027
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Country | US
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Telephone | 954-771-1901
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | SUSAN WASSELLE
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Credential |
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Telephone | 907-223-1013
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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