Provider Demographics
NPI:1659827517
Name:GERGENS, WAYNE (DDS)
Entity type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:
Last Name:GERGENS
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 1:110 W 6TH AVE STE 161
Mailing Address - Street 2:
Mailing Address - City:ELLENSBURG
Mailing Address - State:WA
Mailing Address - Zip Code:98926-3106
Mailing Address - Country:US
Mailing Address - Phone:806-679-1788
Mailing Address - Fax:
Practice Address - Street 1:19720 68TH AVE W
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-4568
Practice Address - Country:US
Practice Address - Phone:806-679-1788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-31
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7329122300000X
WADE60771319122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist