Provider Demographics
NPI:1063537207
Name:WEHRENBERG, KENNETH R (DMD MS)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:R
Last Name:WEHRENBERG
Suffix:
Gender:M
Credentials:DMD MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1074 STONE HILL HWY
Mailing Address - Street 2:
Mailing Address - City:HERMANN
Mailing Address - State:MO
Mailing Address - Zip Code:65041-1207
Mailing Address - Country:US
Mailing Address - Phone:573-486-2101
Mailing Address - Fax:618-282-6813
Practice Address - Street 1:1074 STONE HILL HWY
Practice Address - Street 2:
Practice Address - City:HERMANN
Practice Address - State:MO
Practice Address - Zip Code:65041-1207
Practice Address - Country:US
Practice Address - Phone:573-486-2101
Practice Address - Fax:618-282-6813
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MODEO134331223X0400X
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Not Answered122300000XDental ProvidersDentist