MEDICARE: ALBERT WESLEY DDS

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	051295	MI
2	1223P0106X	Oral and Maxillofacial Pathology Dentistry	2901015295	MI

General Provider Information

NPI Number	:	1073770855
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALBERT WESLEY DDS

Provider Business Mailing Address
First Line	:	3753 ORION RD
Second Line	:
City	:	OAKLAND
State	:	MI
Zip	:	48363-3032
Country	:	US
Telephone Number	:	248-672-8118
Fax Number	:	248-601-4462

Provider Business Practice Location Address
First Line	:	3753 ORION RD
Second Line	:
City	:	OAKLAND
State	:	MI
Zip	:	48363-3032
Country	:	US
Telephone Number	:	248-672-8118
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2008
Last Update Date	:	07/31/2019

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Directions to “ ALBERT WESLEY DDS” Practice Location

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