Provider Demographics
NPI:1235413691
Name:WENGER, REID MICHAEL (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:REID
Middle Name:MICHAEL
Last Name:WENGER
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 N CHILLICOTHE RD
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:OH
Mailing Address - Zip Code:44202-8739
Mailing Address - Country:US
Mailing Address - Phone:330-995-9944
Mailing Address - Fax:330-995-5177
Practice Address - Street 1:75 N CHILLICOTHE RD
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:OH
Practice Address - Zip Code:44202-8739
Practice Address - Country:US
Practice Address - Phone:330-995-9944
Practice Address - Fax:330-995-5177
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-04
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30 0217081223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics