Provider Demographics
NPI:1013113992
Name:DUFRENE, WANDA ANN (DMD)
Entity Type:Individual
Prefix:DR
First Name:WANDA
Middle Name:ANN
Last Name:DUFRENE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 S TOWNSEND AVE
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-5446
Mailing Address - Country:US
Mailing Address - Phone:970-252-8896
Mailing Address - Fax:970-240-3095
Practice Address - Street 1:1901 S TOWNSEND AVE
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-5446
Practice Address - Country:US
Practice Address - Phone:970-252-8896
Practice Address - Fax:970-240-3095
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7079122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO91232767Medicaid