MEDICARE: DR. MARK SCOTT WENZEL 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	1223G0001X	General Practice Dentistry	18868	OH

General Provider Information

NPI Number	:	1710963194
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK SCOTT WENZEL DDS

Provider Business Mailing Address
First Line	:	1530 CAMBRON CT
Second Line	:
City	:	VANDALIA
State	:	OH
Zip	:	45377-9754
Country	:	US
Telephone Number	:	937-898-3943
Fax Number	:

Provider Business Practice Location Address
First Line	:	7083 CORPORATE WAY
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45459-4223
Country	:	US
Telephone Number	:	937-434-1151
Fax Number	:	937-434-0698

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

Provider Enumeration Date	:	12/19/2005
Last Update Date	:	08/29/2007

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