Provider Demographics
NPI:1154335545
Name:WETMORE, DALE MELVIN (DDS)
Entity type:Individual
Prefix:DR
First Name:DALE
Middle Name:MELVIN
Last Name:WETMORE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 COMMONWEALTH AVE
Mailing Address - Street 2:#305
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116
Mailing Address - Country:US
Mailing Address - Phone:617-536-7168
Mailing Address - Fax:617-536-6634
Practice Address - Street 1:29 COMMONWEALTH AVE
Practice Address - Street 2:#305
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116
Practice Address - Country:US
Practice Address - Phone:617-536-7168
Practice Address - Fax:617-536-6634
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA127551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice