Provider Demographics
NPI:1144853094
Name:WESLEY JOHNSON ,DDS,INC.,PS
Entity type:Organization
Organization Name:WESLEY JOHNSON ,DDS,INC.,PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:E
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:509-674-5153
Mailing Address - Street 1:PO BOX 580
Mailing Address - Street 2:
Mailing Address - City:CLE ELUM
Mailing Address - State:WA
Mailing Address - Zip Code:98922-0580
Mailing Address - Country:US
Mailing Address - Phone:509-674-5153
Mailing Address - Fax:509-674-7354
Practice Address - Street 1:101 N HARRIS AVE
Practice Address - Street 2:
Practice Address - City:CLE ELUM
Practice Address - State:WA
Practice Address - Zip Code:98922-1119
Practice Address - Country:US
Practice Address - Phone:509-674-5153
Practice Address - Fax:509-674-7354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-19
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental