Provider Demographics
NPI:1801974811
Name:WENKER, DONALD WAYNE (DDS)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:WAYNE
Last Name:WENKER
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 1:13515 NE 175TH ST
Mailing Address - Street 2:
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98072-8566
Mailing Address - Country:US
Mailing Address - Phone:425-481-2349
Mailing Address - Fax:425-481-6089
Practice Address - Street 1:13515 NE 175TH ST
Practice Address - Street 2:
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98072-8566
Practice Address - Country:US
Practice Address - Phone:425-481-2349
Practice Address - Fax:425-481-6089
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA5043122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist