MEDICARE: DR. COURTNEY ANN WEDEL D.D.S

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	122300000X	Dentist	6307	OK

General Provider Information

NPI Number	:	1801167663
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. COURTNEY ANN WEDEL D.D.S

Provider Business Mailing Address
First Line	:	500 N. FINANCIAL CENTER TERRACE
Second Line	:
City	:	MUSTANG
State	:	OK
Zip	:	73064-0000
Country	:	US
Telephone Number	:	405-376-2072
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 N FINANCIAL TER STE D
Second Line	:
City	:	MUSTANG
State	:	OK
Zip	:	73064-4432
Country	:	US
Telephone Number	:	405-376-2072
Fax Number	:

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

Provider Enumeration Date	:	01/25/2012
Last Update Date	:	01/25/2012

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