MEDICARE: DR. WENDY S GULDEN D.D.S. M.S.

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	1223E0200X	Endodontics	D11249	MN

General Provider Information

NPI Number	:	1801991385
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WENDY S GULDEN D.D.S. M.S.

Provider Business Mailing Address
First Line	:	4437 LAKE AVE S
Second Line	:
City	:	WHITE BEAR LAKE
State	:	MN
Zip	:	55110-3455
Country	:	US
Telephone Number	:	651-429-3535
Fax Number	:

Provider Business Practice Location Address
First Line	:	4437 LAKE AVE S
Second Line	:
City	:	WHITE BEAR LAKE
State	:	MN
Zip	:	55110-3455
Country	:	US
Telephone Number	:	651-429-3535
Fax Number	:

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

Provider Enumeration Date	:	09/13/2006
Last Update Date	:	07/08/2007

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