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General NPI Number Information
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NPI Number | 1598101628
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Entity Type | Organization
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Legal Business Name | WENTZ ORTHODONTICS
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Dates
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Enumeration Date | 05/15/2013
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Last Update Date | 05/15/2013
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Provider Practice Location Address
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Address Line | 701 UNIVERSITY AVE
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City | FAIRBANKS
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State | AK
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Zip | 99709-3646
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Country | US
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Telephone | 907-452-7223
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Fax | 907-452-1293
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Provider Business Mailing Address
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Address Line | 701 UNIVERSITY AVE
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City | FAIRBANKS
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State | AK
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Zip | 99709-3646
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Country | US
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Telephone | 907-452-7223
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Fax | 907-452-1293
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | MRS. NATALIE WENTZ
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Credential |
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Telephone | 907-452-7223
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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 | 847
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License Number State | AK
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