Provider Demographics
NPI:1699071092
Name:WESSLING, JERRY BRIAN (DDS)
Entity type:Individual
Prefix:
First Name:JERRY
Middle Name:BRIAN
Last Name:WESSLING
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 1:597 'E' STREET
Mailing Address - Street 2:
Mailing Address - City:DAVID CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68632
Mailing Address - Country:US
Mailing Address - Phone:402-367-3005
Mailing Address - Fax:402-367-3005
Practice Address - Street 1:597 'E' STREET
Practice Address - Street 2:
Practice Address - City:DAVID CITY
Practice Address - State:NE
Practice Address - Zip Code:68632
Practice Address - Country:US
Practice Address - Phone:402-367-3005
Practice Address - Fax:402-367-3005
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-02
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE5738122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist