Provider Demographics
NPI:1780988329
Name:WENDROFF, IRA M
Entity type:Individual
Prefix:DR
First Name:IRA
Middle Name:M
Last Name:WENDROFF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7301-A W. PALMETTO PK. RD.
Mailing Address - Street 2:SUITE 300B
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433
Mailing Address - Country:US
Mailing Address - Phone:561-338-6549
Mailing Address - Fax:561-338-6959
Practice Address - Street 1:7301-A W. PALMETTO PK. RD.
Practice Address - Street 2:SUITE 300B
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433
Practice Address - Country:US
Practice Address - Phone:561-338-6549
Practice Address - Fax:561-338-6959
Is Sole Proprietor?:No
Enumeration Date:2010-12-22
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN131981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice