Provider Demographics
NPI:1851518245
Name:WENGER ORTHODONTICS, INC
Entity Type:Organization
Organization Name:WENGER ORTHODONTICS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRENCE
Authorized Official - Middle Name:L
Authorized Official - Last Name:WENGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-442-0916
Mailing Address - Street 1:6801 MAYFIELD RD
Mailing Address - Street 2:SUITE 233
Mailing Address - City:MAYFIELD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-2270
Mailing Address - Country:US
Mailing Address - Phone:440-442-0916
Mailing Address - Fax:440-442-0960
Practice Address - Street 1:6801 MAYFIELD RD
Practice Address - Street 2:SUITE 233
Practice Address - City:MAYFIELD HTS
Practice Address - State:OH
Practice Address - Zip Code:44124-2270
Practice Address - Country:US
Practice Address - Phone:440-442-0916
Practice Address - Fax:440-442-0960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH131841223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty