Provider Demographics
NPI:1134282171
Name:DAVID, WENDELL KEITH (DDS)
Entity Type:Individual
Prefix:
First Name:WENDELL
Middle Name:KEITH
Last Name:DAVID
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:PO BOX 2485
Mailing Address - Street 2:
Mailing Address - City:SOUTH PADRE ISLAND
Mailing Address - State:TX
Mailing Address - Zip Code:78597-2485
Mailing Address - Country:US
Mailing Address - Phone:956-546-2973
Mailing Address - Fax:
Practice Address - Street 1:2334 BOCA CHICA BLVD STE 200
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-2697
Practice Address - Country:US
Practice Address - Phone:956-546-2973
Practice Address - Fax:956-546-1342
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX183571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice