Healthcare Provider Details

I. General information

NPI: 1326161605
Provider Name (Legal Business Name): BRENT ARTHUR WENZEL DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 01/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

153 W 151ST ST STE 130
OLATHE KS
66061-5300
US

IV. Provider business mailing address

153 W 151ST ST STE 130
OLATHE KS
66061-5300
US

V. Phone/Fax

Practice location:
  • Phone: 913-764-8883
  • Fax:
Mailing address:
  • Phone: 913-764-8883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number2006025630
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number60867
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number2006025630
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number6644-015
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: