MEDICARE: DR. WALTER KARL WEXEL 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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	0401005690	VA

General Provider Information

NPI Number	:	1235267865
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WALTER KARL WEXEL DDS

Provider Business Mailing Address
First Line	:	2040 THOMAS BISHOP LN
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454
Country	:	US
Telephone Number	:	757-481-3517
Fax Number	:	757-257-0256

Provider Business Practice Location Address
First Line	:	2140 GREAT NECK SQ
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454
Country	:	US
Telephone Number	:	757-681-8181
Fax Number	:	757-257-0256

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

Provider Enumeration Date	:	03/02/2007
Last Update Date	:	07/08/2007

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