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General NPI Number Information
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NPI Number | 1508412149
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Entity Type | Individual
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Provider Name | PATRICK WENDLING DMD
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Gender | Male
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Dates
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Enumeration Date | 08/09/2019
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Last Update Date | 08/09/2019
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Provider Practice Location Address
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Address Line | 2424 CHARTRES ST
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City | LA SALLE
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State | IL
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Zip | 61301-1107
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Country | US
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Telephone | 815-223-6013
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Fax |
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Provider Business Mailing Address
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Address Line | 14613 S STONEGATE DR
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City | HOMER GLEN
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State | IL
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Zip | 60491-6783
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Country | US
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Telephone | 630-512-1115
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Fax |
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019.032126
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License Number State | IL
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