Provider Demographics
NPI:1649765413
Name:WENZEL, CHARLES T (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:T
Last Name:WENZEL
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 1:414 BENSON AVE NE APT 1257
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-0042
Mailing Address - Country:US
Mailing Address - Phone:989-493-0701
Mailing Address - Fax:
Practice Address - Street 1:9041 N RODGERS CT SE
Practice Address - Street 2:
Practice Address - City:CALEDONIA
Practice Address - State:MI
Practice Address - Zip Code:49316-7660
Practice Address - Country:US
Practice Address - Phone:616-891-8931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-25
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901022741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice