1811390552 NPI number — DR. RYAN TERRENCE WENGER DDS,MSD

Table of content: DR. RYAN TERRENCE WENGER DDS,MSD (NPI 1811390552)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811390552 NPI number — DR. RYAN TERRENCE WENGER DDS,MSD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WENGER
Provider First Name:
RYAN
Provider Middle Name:
TERRENCE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS,MSD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811390552
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/08/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5825 LANDERBROOK DR
Provider Second Line Business Mailing Address:
SUITE 224
Provider Business Mailing Address City Name:
MAYFIELD HTS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44124-6532
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-442-0916
Provider Business Mailing Address Fax Number:
440-442-0960

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5825 LANDERBROOK DR
Provider Second Line Business Practice Location Address:
SUITE 224
Provider Business Practice Location Address City Name:
MAYFIELD HTS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44124-6532
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-442-0916
Provider Business Practice Location Address Fax Number:
440-442-0960
Provider Enumeration Date:
10/08/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223X0400X , with the licence number:  20815 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com