Provider Demographics
NPI:1811390552
Name:WENGER, RYAN TERRENCE (DDS,MSD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:TERRENCE
Last Name:WENGER
Suffix:
Gender:M
Credentials:DDS,MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5825 LANDERBROOK DR
Mailing Address - Street 2:SUITE 224
Mailing Address - City:MAYFIELD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-6532
Mailing Address - Country:US
Mailing Address - Phone:440-442-0916
Mailing Address - Fax:440-442-0960
Practice Address - Street 1:5825 LANDERBROOK DR
Practice Address - Street 2:SUITE 224
Practice Address - City:MAYFIELD HTS
Practice Address - State:OH
Practice Address - Zip Code:44124-6532
Practice Address - Country:US
Practice Address - Phone:440-442-0916
Practice Address - Fax:440-442-0960
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-08
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH208151223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics