Provider Demographics
NPI:1922139294
Name:DOUGLAS C WENDT, JR., D.D.S.
Entity Type:Organization
Organization Name:DOUGLAS C WENDT, JR., D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR. DOUGLAS C. WENDT, JR., D.D.S.
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:C
Authorized Official - Last Name:WENDT
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:813-684-8085
Mailing Address - Street 1:268 S MOON AVE
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5711
Mailing Address - Country:US
Mailing Address - Phone:813-684-8085
Mailing Address - Fax:813-684-7971
Practice Address - Street 1:268 S MOON AVE
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5711
Practice Address - Country:US
Practice Address - Phone:813-684-8085
Practice Address - Fax:813-684-7971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101961223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty