Provider Demographics
NPI:1457579336
Name:WENNERSTEN, DONALD (DDS)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:
Last Name:WENNERSTEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:DONALD
Other - Middle Name:A
Other - Last Name:WENNERSTEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:75 SCIO CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-6119
Mailing Address - Country:US
Mailing Address - Phone:734-668-9988
Mailing Address - Fax:734-668-8838
Practice Address - Street 1:75 SCIO CHURCH RD
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-6119
Practice Address - Country:US
Practice Address - Phone:734-668-9988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010157081223G0001X
MI15708122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice