Provider Demographics
NPI:1003291154
Name:WENZEL, ALEXANDRA A (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDRA
Middle Name:A
Last Name:WENZEL
Suffix:
Gender:F
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:PO BOX 126
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE DU SAC
Mailing Address - State:WI
Mailing Address - Zip Code:53578-0126
Mailing Address - Country:US
Mailing Address - Phone:608-643-3855
Mailing Address - Fax:608-643-6295
Practice Address - Street 1:8667 US HIGHWAY 42 STE 100
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:KY
Practice Address - Zip Code:41091-8759
Practice Address - Country:US
Practice Address - Phone:859-384-0393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-29
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10011821223G0001X
CA1001021223G0001X
OH30.0255921223G0001X
KY102041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice