Provider Demographics
NPI:1225075963
Name:WEN, DENNIS Y (MD)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:Y
Last Name:WEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 N CLYDE MORRIS BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-2765
Mailing Address - Country:US
Mailing Address - Phone:386-425-4165
Mailing Address - Fax:
Practice Address - Street 1:201 N CLYDE MORRIS BLVD STE 200
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-2765
Practice Address - Country:US
Practice Address - Phone:386-425-4165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME160181207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO80082254OtherRR MEDICARE
MO208015305Medicaid
MO969505236Medicare PIN
MO056011950Medicare PIN
MOF55174Medicare UPIN
MO80082254OtherRR MEDICARE