Provider Demographics
NPI:1174508972
Name:JERRY L WENDER DDS PA
Entity Type:Organization
Organization Name:JERRY L WENDER DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:WENDER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-859-9073
Mailing Address - Street 1:8955 HIGHWAY 6 NORTH
Mailing Address - Street 2:STE 200
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77095
Mailing Address - Country:US
Mailing Address - Phone:281-859-9073
Mailing Address - Fax:281-859-0211
Practice Address - Street 1:8955 HIGHWAY 6 NORTH
Practice Address - Street 2:STE 200
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77095
Practice Address - Country:US
Practice Address - Phone:281-859-9073
Practice Address - Fax:281-859-0211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty