MEDICARE: JOSEPH WENZINGER 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	2395	NV

General Provider Information

NPI Number	:	1457593204
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH WENZINGER DDS

Provider Business Mailing Address
First Line	:	3815 SOUTH JONES #2
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103
Country	:	US
Telephone Number	:	702-873-8556
Fax Number	:

Provider Business Practice Location Address
First Line	:	3815 S JONES BLVD STE 2
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-2289
Country	:	US
Telephone Number	:	702-873-8556
Fax Number	:

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

Provider Enumeration Date	:	03/25/2009
Last Update Date	:	03/25/2009

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