Provider Demographics
NPI:1922122100
Name:WENHAM, GRACE YANG (DMD)
Entity Type:Individual
Prefix:DR
First Name:GRACE
Middle Name:YANG
Last Name:WENHAM
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:GRACE
Other - Middle Name:ANGELA
Other - Last Name:YANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:100 RIVER PL
Mailing Address - Street 2:SUITE 110
Mailing Address - City:MONONA
Mailing Address - State:WI
Mailing Address - Zip Code:53716-4041
Mailing Address - Country:US
Mailing Address - Phone:608-222-6160
Mailing Address - Fax:
Practice Address - Street 1:100 RIVER PL
Practice Address - Street 2:SUITE 110
Practice Address - City:MONONA
Practice Address - State:WI
Practice Address - Zip Code:53716-4041
Practice Address - Country:US
Practice Address - Phone:608-222-6160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA214321223G0001X
WI6347-151223G0001X
FLDN 173081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice