Provider Demographics
NPI:1265572655
Name:DR P J WENK & DR P A WENK PC
Entity type:Organization
Organization Name:DR P J WENK & DR P A WENK PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:BIBLE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:865-457-2860
Mailing Address - Street 1:123 LEINART ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:TN
Mailing Address - Zip Code:37716-3626
Mailing Address - Country:US
Mailing Address - Phone:865-457-2860
Mailing Address - Fax:865-457-5602
Practice Address - Street 1:123 LEINART ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:TN
Practice Address - Zip Code:37716-3626
Practice Address - Country:US
Practice Address - Phone:865-457-2860
Practice Address - Fax:865-457-5602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS0000007253122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty