MEDICARE: BRYAN WENDELL DDS

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	122300000X	Dentist	0401413563	VA

General Provider Information

NPI Number	:	1619269172
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRYAN WENDELL DDS

Provider Business Mailing Address
First Line	:	113 HAMPTON HWY
Second Line	:
City	:	YORKTOWN
State	:	VA
Zip	:	23693-3510
Country	:	US
Telephone Number	:	757-867-8765
Fax Number	:

Provider Business Practice Location Address
First Line	:	113 HAMPTON HWY
Second Line	:
City	:	YORKTOWN
State	:	VA
Zip	:	23693-3510
Country	:	US
Telephone Number	:	757-867-8765
Fax Number	:

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

Provider Enumeration Date	:	05/03/2011
Last Update Date	:	11/01/2025

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