MEDICARE: MR. WENTZEL WRIGHT OWENS JR. DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	12007642A	IN

General Provider Information

NPI Number	:	1093867632
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WENTZEL WRIGHT OWENS JR. DDS

Provider Business Mailing Address
First Line	:	349 EAST MAIN STREET
Second Line	:
City	:	WHITELAND
State	:	IN
Zip	:	46184-1514
Country	:	US
Telephone Number	:	317-535-4877
Fax Number	:	317-535-4877

Provider Business Practice Location Address
First Line	:	349 EAST MAIN STREET
Second Line	:
City	:	WHITELAND
State	:	IN
Zip	:	46184-1514
Country	:	US
Telephone Number	:	317-535-4877
Fax Number	:	317-535-4877

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	07/08/2007

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