Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 3134 | NH |
NPI | 1063424844 |
---|---|
Provider Name | Gary Don Wendell |
First Address | Rochester, NH 03867 |
Second Address | Rochester, NH 03867 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30300498 | (05) | NH |