Provider Demographics
NPI:1841512514
Name:BREITHAUPT, WENDELL T JR (DMD)
Entity type:Individual
Prefix:DR
First Name:WENDELL
Middle Name:T
Last Name:BREITHAUPT
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 SOUTH MAIN STREET
Mailing Address - Street 2:DENTAL HEALTH ASSOCIATES
Mailing Address - City:PHILLIPSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08865
Mailing Address - Country:US
Mailing Address - Phone:908-454-9800
Mailing Address - Fax:908-387-8322
Practice Address - Street 1:320 SOUTH MAIN STREET
Practice Address - Street 2:DENTAL HEALTH ASSOCIATES
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865
Practice Address - Country:US
Practice Address - Phone:908-454-9800
Practice Address - Fax:908-387-8322
Is Sole Proprietor?:No
Enumeration Date:2010-02-23
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI161671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice