MEDICARE: DR. SUZANNE LYNN WENZLAFF D.D.S.

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	18954	CA

General Provider Information

NPI Number	:	1639280969
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUZANNE LYNN WENZLAFF D.D.S.

Provider Business Mailing Address
First Line	:	3247 WAVERLY DRIVE
Second Line	:
City	:	L.A.
State	:	CA
Zip	:	90027
Country	:	US
Telephone Number	:	323-668-1186
Fax Number	:

Provider Business Practice Location Address
First Line	:	925 W. 34TH ST
Second Line	:	UNIVERSITY OF SOUTHERN CA SCHOOL OF DENTISTRY
City	:	LOS ANGELES
State	:	CA
Zip	:	90089
Country	:	US
Telephone Number	:	323-445-0146
Fax Number	:

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	12/01/2010

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