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General NPI Number Information
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NPI Number | 1205567849
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Entity Type | Organization
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Legal Business Name | TIM WENTZLOFF DDS PC
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Dates
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Enumeration Date | 06/23/2022
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Last Update Date | 06/23/2022
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Provider Practice Location Address
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Address Line | 876 E FRONT ST
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City | TRAVERSE CITY
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State | MI
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Zip | 49686-2704
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Country | US
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Telephone | 231-947-6880
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Fax |
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Provider Business Mailing Address
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Address Line | 6597 DEEPWATER POINT RD
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City | WILLIAMSBURG
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State | MI
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Zip | 49690-9246
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Country | US
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Telephone | 231-383-0382
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | TIMOTHY DONALD WENTZLOFF
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Credential | DDS
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Telephone | 231-383-0382
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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