Provider Demographics
NPI:1083895213
Name:WENDELL N. ROW, DDS, INC.
Entity Type:Organization
Organization Name:WENDELL N. ROW, DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY-TREASURER OF THE CORPORAT
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-442-1775
Mailing Address - Street 1:3132 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95503-5638
Mailing Address - Country:US
Mailing Address - Phone:707-442-1775
Mailing Address - Fax:707-444-2821
Practice Address - Street 1:3132 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95503-5638
Practice Address - Country:US
Practice Address - Phone:707-442-1775
Practice Address - Fax:707-444-2821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADT26226261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1750404497OtherSOLE PROPRIETOR NPI NUMBE