Provider Demographics
NPI:1437860806
Name:WENTZ, PARKER DAVID (DDS)
Entity Type:Individual
Prefix:DR
First Name:PARKER
Middle Name:DAVID
Last Name:WENTZ
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 1:3510 83RD DR
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79423-2656
Mailing Address - Country:US
Mailing Address - Phone:806-577-6933
Mailing Address - Fax:
Practice Address - Street 1:4013 84TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79423-1913
Practice Address - Country:US
Practice Address - Phone:806-792-7223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-07
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX370351223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics