Provider Demographics
NPI:1871021709
Name:WANDELL, ADAM JOSHUA FARRELL (DDS, MD)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:JOSHUA FARRELL
Last Name:WANDELL
Suffix:
Gender:M
Credentials:DDS, MD
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:9961 HERB RD
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CA
Mailing Address - Zip Code:95492-9435
Mailing Address - Country:US
Mailing Address - Phone:650-714-3694
Mailing Address - Fax:
Practice Address - Street 1:445 MARCH AVE STE B
Practice Address - Street 2:
Practice Address - City:HEALDSBURG
Practice Address - State:CA
Practice Address - Zip Code:95448-3383
Practice Address - Country:US
Practice Address - Phone:650-714-3694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-23
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA1059371223S0112X, 204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery