Healthcare Provider Details

I. General information

NPI: 1962590877
Provider Name (Legal Business Name): STEPHEN V WENDT MD DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 09/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13215 BIRCH DR SUITE 100
OMAHA NE
68164-5431
US

IV. Provider business mailing address

1437 E 23RD ST
FREMONT NE
68025-2433
US

V. Phone/Fax

Practice location:
  • Phone: 402-390-0770
  • Fax: 402-397-1074
Mailing address:
  • Phone: 402-721-3600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number18252
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: