Provider Demographics
NPI:1932364825
Name:WENDER, JERRY L (DDS)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:L
Last Name:WENDER
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 1:8955 HIGHWAY 6 N
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77095-2320
Mailing Address - Country:US
Mailing Address - Phone:281-895-9073
Mailing Address - Fax:
Practice Address - Street 1:8955 HIGHWAY 6 N
Practice Address - Street 2:SUITE 200
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77095-2320
Practice Address - Country:US
Practice Address - Phone:281-895-9073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-21
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice