Provider Demographics
NPI:1366644247
Name:WENTLING, KERRY L (DMD)
Entity Type:Individual
Prefix:DR
First Name:KERRY
Middle Name:L
Last Name:WENTLING
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 S RAILROAD ST
Mailing Address - Street 2:
Mailing Address - City:MYERSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17067-1343
Mailing Address - Country:US
Mailing Address - Phone:717-866-4825
Mailing Address - Fax:717-866-5261
Practice Address - Street 1:22 S RAILROAD ST
Practice Address - Street 2:
Practice Address - City:MYERSTOWN
Practice Address - State:PA
Practice Address - Zip Code:17067-1343
Practice Address - Country:US
Practice Address - Phone:717-866-4825
Practice Address - Fax:717-866-5261
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-025398L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice