MEDICARE: DR. MATTHEW SCOTT WENZEL DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	2008024669	MO

General Provider Information

NPI Number	:	1316198518
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW SCOTT WENZEL DMD

Provider Business Mailing Address
First Line	:	8045 BIG BEND BLVD
Second Line	:	SUITE 203
City	:	WEBSTER GROVES
State	:	MO
Zip	:	63119-2714
Country	:	US
Telephone Number	:	314-918-9666
Fax Number	:

Provider Business Practice Location Address
First Line	:	8045 BIG BEND BLVD
Second Line	:	SUITE 203
City	:	WEBSTER GROVES
State	:	MO
Zip	:	63119-2714
Country	:	US
Telephone Number	:	314-918-9666
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/06/2008
Last Update Date	:	01/09/2016

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