Provider Demographics
NPI:1679670772
Name:WENDLING, AMY E (DDS)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:E
Last Name:WENDLING
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 1:13403 E 13 MILE RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48088-3188
Mailing Address - Country:US
Mailing Address - Phone:586-979-2800
Mailing Address - Fax:203-880-1361
Practice Address - Street 1:13403 E 13 MILE RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48088-3188
Practice Address - Country:US
Practice Address - Phone:586-979-2800
Practice Address - Fax:203-880-1361
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29-010193921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4900750Medicaid