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General NPI Number Information
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NPI Number | 1063424844
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Entity Type | Individual
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Provider Name | GARY DON WENDELL D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 08/12/2006
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Last Update Date | 09/21/2023
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Provider Practice Location Address
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Address Line | 5354 LOOKOUT PASS
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City | WESLEY CHAPEL
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State | FL
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Zip | 33544-5501
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Country | US
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Telephone | 425-517-9316
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Fax | 628-237-0456
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Provider Business Mailing Address
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Address Line | 5354 LOOKOUT PASS
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City | WESLEY CHAPEL
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State | FL
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Zip | 33544-5501
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Country | US
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Telephone | 425-517-9316
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Fax | 628-237-0456
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 104801
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 61041300
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 3134
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License Number State | NH
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