Provider Demographics
NPI:1447409131
Name:WENHAM, THOMAS R (DMD, MMSC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:R
Last Name:WENHAM
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Gender:M
Credentials:DMD, MMSC
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:100 RIVER PL
Mailing Address - Street 2:SUITE 110
Mailing Address - City:MONONA
Mailing Address - State:WI
Mailing Address - Zip Code:53716-4041
Mailing Address - Country:US
Mailing Address - Phone:608-222-6160
Mailing Address - Fax:608-222-6248
Practice Address - Street 1:100 RIVER PL
Practice Address - Street 2:SUITE 110
Practice Address - City:MONONA
Practice Address - State:WI
Practice Address - Zip Code:53716-4041
Practice Address - Country:US
Practice Address - Phone:608-222-6160
Practice Address - Fax:608-222-6248
Is Sole Proprietor?:No
Enumeration Date:2008-09-17
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI6308-0151223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics