Provider Demographics
NPI:1255064168
Name:WEHNER, PAUL (DMD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:WEHNER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 S RIVERVIEW DR
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:IN
Mailing Address - Zip Code:47243-8931
Mailing Address - Country:US
Mailing Address - Phone:812-801-3954
Mailing Address - Fax:
Practice Address - Street 1:1105 CLIFTY DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:IN
Practice Address - Zip Code:47250-1614
Practice Address - Country:US
Practice Address - Phone:812-273-0207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-07
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12013867A1223G0001X
TN121201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice