Provider Demographics
NPI:1942671433
Name:VIENNEAU, WENDY ANN (DDS)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:ANN
Last Name:VIENNEAU
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4011 S 35TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68107-1307
Mailing Address - Country:US
Mailing Address - Phone:402-212-5478
Mailing Address - Fax:
Practice Address - Street 1:10950 SAN JOSE BLVD STE 64
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-6671
Practice Address - Country:US
Practice Address - Phone:904-260-4244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-09
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7256122300000X
FLDN23066122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist