Provider Demographics
NPI:1679952089
Name:WENGER, TYLER (DDS)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:
Last Name:WENGER
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 1:370 E MILLTOWN RD STE A
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-1280
Mailing Address - Country:US
Mailing Address - Phone:330-345-5858
Mailing Address - Fax:
Practice Address - Street 1:370 E MILLTOWN RD STE A
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-1280
Practice Address - Country:US
Practice Address - Phone:330-345-5858
Practice Address - Fax:330-345-5888
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-19
Last Update Date:2022-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0244891223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice