Provider Demographics
NPI:1295750396
Name:WENDA, EDWARD A (DDS)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:A
Last Name:WENDA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9500 FALLS OF NEUSE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-2466
Mailing Address - Country:US
Mailing Address - Phone:919-845-7778
Mailing Address - Fax:
Practice Address - Street 1:9500 FALLS OF NEUSE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-2466
Practice Address - Country:US
Practice Address - Phone:919-845-7778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC71931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice