Provider Demographics
NPI:1710963194
Name:WENZEL, MARK SCOTT (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:SCOTT
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 1:1530 CAMBRON CT
Mailing Address - Street 2:
Mailing Address - City:VANDALIA
Mailing Address - State:OH
Mailing Address - Zip Code:45377-9754
Mailing Address - Country:US
Mailing Address - Phone:937-898-3943
Mailing Address - Fax:
Practice Address - Street 1:7083 CORPORATE WAY
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-4223
Practice Address - Country:US
Practice Address - Phone:937-434-1151
Practice Address - Fax:937-434-0698
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH188681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice