Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 2901020168 | MI |
NPI | 1013225077 |
---|---|
Provider Name | Dr. Sarah Elisabeth Wentzel |
First Address | Canton, MI 48187-1661 |
Second Address | Canton, MI 48187-1661 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2010 |
Last Update Date | 23/09/2010 |