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General NPI Number Information
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NPI Number | 1508448846
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Entity Type | Organization
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Legal Business Name | WOLFENDEN FAMILY DENTAL, PLLC
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Dates
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Enumeration Date | 04/26/2021
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Last Update Date | 11/22/2022
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Provider Practice Location Address
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Address Line | 430 BIMSON AVE
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City | BERTHOUD
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State | CO
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Zip | 80513-1395
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Country | US
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Telephone | 970-236-7448
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Fax |
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Provider Business Mailing Address
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Address Line | 329 BRONCO CT
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City | BERTHOUD
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State | CO
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Zip | 80513-2829
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | KEITH WOLFENDEN
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Credential | DMD
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Telephone | 727-457-3418
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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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