Provider Demographics
NPI:1053691725
Name:TODD E WESSLEN DDS MS INC
Entity type:Organization
Organization Name:TODD E WESSLEN DDS MS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:WESSLEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:559-732-5658
Mailing Address - Street 1:426 S GARDEN ST
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-2810
Mailing Address - Country:US
Mailing Address - Phone:559-732-5658
Mailing Address - Fax:559-732-1958
Practice Address - Street 1:426 S GARDEN ST
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-2810
Practice Address - Country:US
Practice Address - Phone:559-732-5658
Practice Address - Fax:559-732-1958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-25
Last Update Date:2011-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA584911223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty