Provider Demographics
NPI:1245428309
Name:TROUTMAN, WENDY JO (DDS)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:JO
Last Name:TROUTMAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 1ST ST W
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:IA
Mailing Address - Zip Code:50644-2604
Mailing Address - Country:US
Mailing Address - Phone:319-334-3512
Mailing Address - Fax:
Practice Address - Street 1:223 1ST ST W
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:IA
Practice Address - Zip Code:50644-2604
Practice Address - Country:US
Practice Address - Phone:319-334-3512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-13
Last Update Date:2007-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA082201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice