Provider Demographics
NPI:1164717690
Name:WENSAUER, ANTON (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANTON
Middle Name:
Last Name:WENSAUER
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 1:1921 HILLIARD ROME RD
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-7920
Mailing Address - Country:US
Mailing Address - Phone:614-777-8668
Mailing Address - Fax:
Practice Address - Street 1:7535 STATE RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45255-2438
Practice Address - Country:US
Practice Address - Phone:513-231-5444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-13
Last Update Date:2019-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-024635122300000X
PADH068933124Q00000X
OHRES34421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Yes122300000XDental ProvidersDentist
No124Q00000XDental ProvidersDental Hygienist