Provider Demographics
NPI:1568761575
Name:LINDA WEHNER D.M.D. LLC
Entity Type:Organization
Organization Name:LINDA WEHNER D.M.D. LLC
Other - Org Name:CLIFTY FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER/BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RONNIE
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:WEHNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-273-0207
Mailing Address - Street 1:1105 CLIFTY DRIVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:IN
Mailing Address - Zip Code:47250
Mailing Address - Country:US
Mailing Address - Phone:812-273-0207
Mailing Address - Fax:812-273-3366
Practice Address - Street 1:1105 CLIFTY DRIVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:IN
Practice Address - Zip Code:47250
Practice Address - Country:US
Practice Address - Phone:812-273-0207
Practice Address - Fax:812-273-3366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-17
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009378A1223G0001X
IN12011362A1223G0001X
IN12010214A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty