Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 5684 | OK |
NPI | 1073681789 |
---|---|
Provider Name | Dr. James Andrew Wendelken |
First Address | Oklahoma City, OK 73116 |
Second Address | Oklahoma City, OK 73116 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2006 |
Last Update Date | 28/07/2009 |