Provider Demographics
NPI:1679163083
Name:C. EDWIN WENTZ DDS PA
Entity Type:Organization
Organization Name:C. EDWIN WENTZ DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:C.
Authorized Official - Middle Name:EDWIN
Authorized Official - Last Name:WENTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:806-794-8124
Mailing Address - Street 1:4013 84TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79423-1913
Mailing Address - Country:US
Mailing Address - Phone:806-794-8124
Mailing Address - Fax:
Practice Address - Street 1:1215 W JOE HARVEY BLVD
Practice Address - Street 2:
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240-0907
Practice Address - Country:US
Practice Address - Phone:575-393-6047
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-20
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty