Provider Demographics
NPI:1720098403
Name:WENGERT, GLORIA H (DDS FAGD)
Entity Type:Individual
Prefix:DR
First Name:GLORIA
Middle Name:H
Last Name:WENGERT
Suffix:
Gender:F
Credentials:DDS FAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3803 ATRISCO DR NW
Mailing Address - Street 2:#D
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120
Mailing Address - Country:US
Mailing Address - Phone:505-833-1550
Mailing Address - Fax:505-831-8726
Practice Address - Street 1:3803 ATRISCO DR NW
Practice Address - Street 2:#D
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120
Practice Address - Country:US
Practice Address - Phone:505-833-1550
Practice Address - Fax:505-831-8726
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM13681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice