Provider Demographics
NPI:1003960808
Name:WENZINGER, VAUNE M (GENERAL DENTIST)
Entity Type:Individual
Prefix:DR
First Name:VAUNE
Middle Name:M
Last Name:WENZINGER
Suffix:
Gender:F
Credentials:GENERAL DENTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:531 NE EVERETT ST
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607
Mailing Address - Country:US
Mailing Address - Phone:360-834-4990
Mailing Address - Fax:360-834-3424
Practice Address - Street 1:531 NE EVERETT ST
Practice Address - Street 2:
Practice Address - City:CAMAS
Practice Address - State:WA
Practice Address - Zip Code:98607
Practice Address - Country:US
Practice Address - Phone:360-834-4990
Practice Address - Fax:360-834-3424
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA4993122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA531246OtherUNITED CONCORDIA