Provider Demographics
NPI:1689430761
Name:WESTLAKE ORAL SURGERY
Entity Type:Organization
Organization Name:WESTLAKE ORAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:BERT
Authorized Official - Middle Name:CAMERON
Authorized Official - Last Name:WENDLING
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:214-205-8570
Mailing Address - Street 1:311 W SOUTHLAKE BLVD STE 150
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-6186
Mailing Address - Country:US
Mailing Address - Phone:174-241-1668
Mailing Address - Fax:
Practice Address - Street 1:311 W SOUTHLAKE BLVD STE 150
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6186
Practice Address - Country:US
Practice Address - Phone:817-424-1166
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OMS PHYSICIANS GROUP PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty