Provider Demographics
NPI:1265537823
Name:CHU TANDAR, WENDY (DMD)
Entity type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:
Last Name:CHU TANDAR
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 1:1937 E HERBERT AVE
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84108-1833
Mailing Address - Country:US
Mailing Address - Phone:801-520-0410
Mailing Address - Fax:
Practice Address - Street 1:3377 S ORCHARD DR
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-8005
Practice Address - Country:US
Practice Address - Phone:801-951-8038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5596980-99261223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU99254Medicare UPIN