Healthcare Provider Details

I. General information

NPI: 1033213731
Provider Name (Legal Business Name): EDWARD J. WNEK DDS, MS, LLC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2712 ERIE AVE
CINCINNATI OH
45208-2111
US

IV. Provider business mailing address

2712 ERIE AVE
CINCINNATI OH
45208-2111
US

V. Phone/Fax

Practice location:
  • Phone: 513-871-0324
  • Fax: 513-871-2587
Mailing address:
  • Phone: 513-871-0324
  • Fax: 513-871-2587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number30-01-5005
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: