Healthcare Provider Details

I. General information

NPI: 1073681789
Provider Name (Legal Business Name): JAMES ANDREW WENDELKEN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 07/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3727 NW 63 STREET SUITE 300
OKLAHOMA CITY OK
73116
US

IV. Provider business mailing address

3727 NW 63 STREET SUITE 300
OKLAHOMA CITY OK
73116
US

V. Phone/Fax

Practice location:
  • Phone: 405-848-7994
  • Fax: 405-848-8020
Mailing address:
  • Phone: 405-848-7994
  • Fax: 405-848-8020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number5684
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: