Provider Demographics
NPI:1285910463
Name:WESLEY, GERALD M (DDS,MS)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:M
Last Name:WESLEY
Suffix:
Gender:M
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6240 MCKINLEY RD
Mailing Address - Street 2:
Mailing Address - City:MARINE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48039
Mailing Address - Country:US
Mailing Address - Phone:810-278-1732
Mailing Address - Fax:
Practice Address - Street 1:6240 MCKINLEY RD
Practice Address - Street 2:
Practice Address - City:MARINE CITY
Practice Address - State:MI
Practice Address - Zip Code:48039
Practice Address - Country:US
Practice Address - Phone:810-278-1732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-01
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010146311223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics