Provider Demographics
NPI:1740328533
Name:WENICUR, BARBARA L II
Entity type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:L
Last Name:WENICUR
Suffix:II
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3309 JUAN TABO NE
Mailing Address - Street 2:SUITE B
Mailing Address - City:ABBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-5188
Mailing Address - Country:US
Mailing Address - Phone:505-292-8310
Mailing Address - Fax:
Practice Address - Street 1:3309 JUAN TABO BLVD NE
Practice Address - Street 2:SUITE B
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-5131
Practice Address - Country:US
Practice Address - Phone:505-292-8310
Practice Address - Fax:505-291-0730
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM25871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice