Provider Demographics
NPI:1639280969
Name:WENZLAFF, SUZANNE LYNN (DDS)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:LYNN
Last Name:WENZLAFF
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 1:3247 WAVERLY DRIVE
Mailing Address - Street 2:
Mailing Address - City:L.A.
Mailing Address - State:CA
Mailing Address - Zip Code:90027
Mailing Address - Country:US
Mailing Address - Phone:323-668-1186
Mailing Address - Fax:
Practice Address - Street 1:925 W. 34TH ST
Practice Address - Street 2:UNIVERSITY OF SOUTHERN CA SCHOOL OF DENTISTRY
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90089
Practice Address - Country:US
Practice Address - Phone:323-445-0146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18954122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist