MEDICARE: WEN LIEN DMD

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	122300000X	Dentist	D7994	OR
2	122300000X	Dentist	25176	TX

General Provider Information

NPI Number	:	1669469623
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WEN LIEN DMD

Provider Business Mailing Address
First Line	:	3551 ROGER BROOKE DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78234-4504
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 WILFORD HALL LOOP
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78236-5638
Country	:	US
Telephone Number	:	210-539-6103
Fax Number	:

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

Provider Enumeration Date	:	10/04/2005
Last Update Date	:	03/31/2025

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Directions to “ WEN LIEN DMD” Practice Location

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