Provider Demographics
NPI:1972677672
Name:TAKADA, WEN-CHI (DDS)
Entity Type:Individual
Prefix:DR
First Name:WEN-CHI
Middle Name:
Last Name:TAKADA
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 1:43155 MAIN ST
Mailing Address - Street 2:SUITE 2312
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-1777
Mailing Address - Country:US
Mailing Address - Phone:248-344-1000
Mailing Address - Fax:248-349-3995
Practice Address - Street 1:43155 MAIN ST
Practice Address - Street 2:SUITE 2312
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-1777
Practice Address - Country:US
Practice Address - Phone:248-344-1000
Practice Address - Fax:248-349-3995
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010181551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice