Provider Demographics
NPI:1235142787
Name:WEDEKING, TODD (DDS)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:
Last Name:WEDEKING
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 1:2201 BALFOUR RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-4927
Mailing Address - Country:US
Mailing Address - Phone:925-516-8886
Mailing Address - Fax:925-516-9876
Practice Address - Street 1:2201 BALFOUR RD
Practice Address - Street 2:SUITE D
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-4927
Practice Address - Country:US
Practice Address - Phone:925-516-8886
Practice Address - Fax:925-516-9876
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50191122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA942672498OtherTAX ID NUMBER