Provider Demographics
NPI:1417170572
Name:WENSINK, JAMES MAURICE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MAURICE
Last Name:WENSINK
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 1:19551 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-1409
Mailing Address - Country:US
Mailing Address - Phone:216-692-3777
Mailing Address - Fax:216-692-3688
Practice Address - Street 1:19551 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44117-1409
Practice Address - Country:US
Practice Address - Phone:216-692-3777
Practice Address - Fax:216-692-3688
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0149991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0320610Medicaid