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General NPI Number Information
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NPI Number | 1104624170
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Entity Type | Organization
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Legal Business Name | WENATCHEE WISDOM TEETH PLLC
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Dates
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Enumeration Date | 03/05/2025
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Last Update Date | 03/21/2025
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Provider Practice Location Address
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Address Line | 211 N WHITMAN WAY
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City | WENATCHEE
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State | WA
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Zip | 98801-2192
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Country | US
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Telephone | 509-888-8088
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Fax |
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Provider Business Mailing Address
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Address Line | 211 N WHITMAN WAY
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City | WENATCHEE
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State | WA
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Zip | 98801-2192
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Country | US
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Telephone | 509-888-8088
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Fax |
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Authorized Official
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Title or Position | BUSINESS DIRECTOR
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Name | MR. RICARDO ALFONSO COLUNGA
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Credential |
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Telephone | 509-885-5703
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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