Provider Demographics
NPI:1811074289
Name:WANIER, HERBERT AUGUST (DDS)
Entity type:Individual
Prefix:DR
First Name:HERBERT
Middle Name:AUGUST
Last Name:WANIER
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 1:5033 ARROYO ST
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-5465
Mailing Address - Country:US
Mailing Address - Phone:916-967-7733
Mailing Address - Fax:916-967-5530
Practice Address - Street 1:10425 FAIR OAKS BLVD STE 201
Practice Address - Street 2:
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-7559
Practice Address - Country:US
Practice Address - Phone:916-967-7733
Practice Address - Fax:916-967-5530
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA243531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice