Provider Demographics
NPI:1124552484
Name:VONWENDT, ROBERT (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:VONWENDT
Suffix:
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 1:321 N LARCHMONT BLVD
Mailing Address - Street 2:SUITE #722
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-3025
Mailing Address - Country:US
Mailing Address - Phone:323-466-8607
Mailing Address - Fax:323-466-2214
Practice Address - Street 1:321 N LARCHMONT BLVD
Practice Address - Street 2:SUITE #722
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-3025
Practice Address - Country:US
Practice Address - Phone:323-466-8607
Practice Address - Fax:323-466-2214
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-13
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41126122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist