Healthcare Provider Details

I. General information

NPI: 1295126076
Provider Name (Legal Business Name): ALEXANDER WENNER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2015
Last Update Date: 07/03/2023
Certification Date: 06/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2240 SH-114 STE 650
TROPHY CLUB TX
76262
US

IV. Provider business mailing address

2240 SH 114 STE 650
TROPHY CLUB TX
76262
US

V. Phone/Fax

Practice location:
  • Phone: 175-325-1538
  • Fax:
Mailing address:
  • Phone: 703-474-9018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number34920
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: