Provider Demographics
NPI:1205567849
Name:TIM WENTZLOFF DDS PC
Entity type:Organization
Organization Name:TIM WENTZLOFF DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:WENTZLOFF
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:231-383-0382
Mailing Address - Street 1:6597 DEEPWATER POINT RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:MI
Mailing Address - Zip Code:49690-9246
Mailing Address - Country:US
Mailing Address - Phone:231-383-0382
Mailing Address - Fax:
Practice Address - Street 1:876 E FRONT ST
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-2704
Practice Address - Country:US
Practice Address - Phone:231-947-6880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-23
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental