Provider Demographics
NPI:1093933384
Name:WENNICK, ROBERT E JR (DDS)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:E
Last Name:WENNICK
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 EASTERN AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:GREENCASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:17225-1100
Mailing Address - Country:US
Mailing Address - Phone:717-597-7197
Mailing Address - Fax:717-597-3995
Practice Address - Street 1:50 EASTERN AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:GREENCASTLE
Practice Address - State:PA
Practice Address - Zip Code:17225-1100
Practice Address - Country:US
Practice Address - Phone:717-597-7197
Practice Address - Fax:717-597-3995
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS023144L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice