Provider Demographics
NPI:1063612992
Name:CARDALL, WES RICHARDSON (DMD, MS)
Entity type:Individual
Prefix:DR
First Name:WES
Middle Name:RICHARDSON
Last Name:CARDALL
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1010 CALLOWAY DR
Mailing Address - Street 2:200A
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93312-6391
Mailing Address - Country:US
Mailing Address - Phone:661-665-7600
Mailing Address - Fax:
Practice Address - Street 1:1010 CALLOWAY DR
Practice Address - Street 2:200A
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93312-6391
Practice Address - Country:US
Practice Address - Phone:661-665-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA612591223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics