MEDICARE: ALBERT J. WESLEY, DDS PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	2901015295	MI

General Provider Information

NPI Number	:	1063588242
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALBERT J. WESLEY, DDS PC

Provider Business Mailing Address
First Line	:	3753 ORION RD
Second Line	:
City	:	OAKLAND
State	:	MI
Zip	:	48363-3032
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3753 ORION ROAD
Second Line	:
City	:	OAKLAND
State	:	MI
Zip	:	48363
Country	:	US
Telephone Number	:	248-720-5358
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ALBERT WESLEY
Credential	:
Telephone Number	:	248-720-5358

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	08/20/2019

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