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General NPI Number Information
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NPI Number | 1285813303
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Entity Type | Individual
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Provider Name | /PETER DAMON WENDELL D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 10/25/2007
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Last Update Date | 10/25/2007
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Provider Practice Location Address
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Address Line | 4097 IRONBOUND RD STE A
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City | WILLIAMSBURG
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State | VA
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Zip | 23188-2676
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Country | US
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Telephone | 757-253-1200
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Fax | 757-253-1255
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Provider Business Mailing Address
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Address Line | 4097 IRONBOUND RD STE A
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City | WILLIAMSBURG
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State | VA
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Zip | 23188-2676
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Country | US
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Telephone | 757-253-1200
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Fax | 757-253-1255
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 0401006360
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License Number State | VA
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