Provider Demographics
NPI:1811976061
Name:WEZMAR, ROSS M (DDS)
Entity type:Individual
Prefix:DR
First Name:ROSS
Middle Name:M
Last Name:WEZMAR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
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Mailing Address - Street 1:900 SCHECHTER DRIVE
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702
Mailing Address - Country:US
Mailing Address - Phone:570-822-4181
Mailing Address - Fax:570-208-4984
Practice Address - Street 1:900 SCHECHTER DRIVE
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702
Practice Address - Country:US
Practice Address - Phone:570-822-4181
Practice Address - Fax:570-208-4984
Is Sole Proprietor?:No
Enumeration Date:2006-01-14
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS017699L1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry