Provider Demographics
NPI:1578551503
Name:KOURY, WENDY L (DDS)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:L
Last Name:KOURY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2418 ENTERPRISE DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:MENDOTA HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55120-1143
Mailing Address - Country:US
Mailing Address - Phone:651-452-2116
Mailing Address - Fax:651-452-2695
Practice Address - Street 1:2418 ENTERPRISE DR
Practice Address - Street 2:SUITE B
Practice Address - City:MENDOTA HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55120-1143
Practice Address - Country:US
Practice Address - Phone:651-452-2116
Practice Address - Fax:651-452-2695
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND104011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice