Provider Demographics
NPI:1811210602
Name:WANEK, TIMOTHY W (DDS)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:W
Last Name:WANEK
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 1:1220 AIRLINE RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78412-3473
Mailing Address - Country:US
Mailing Address - Phone:361-993-9551
Mailing Address - Fax:361-991-7887
Practice Address - Street 1:1220 AIRLINE RD
Practice Address - Street 2:SUITE 210
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78412-3473
Practice Address - Country:US
Practice Address - Phone:361-993-9551
Practice Address - Fax:361-991-7887
Is Sole Proprietor?:No
Enumeration Date:2010-03-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15378122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXBW2725010OtherDEA