Provider Demographics
NPI:1104624170
Name:WENATCHEE WISDOM TEETH PLLC
Entity type:Organization
Organization Name:WENATCHEE WISDOM TEETH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:ALFONSO
Authorized Official - Last Name:COLUNGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-885-5703
Mailing Address - Street 1:211 N WHITMAN WAY
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-2192
Mailing Address - Country:US
Mailing Address - Phone:509-888-8088
Mailing Address - Fax:
Practice Address - Street 1:211 N WHITMAN WAY
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-2192
Practice Address - Country:US
Practice Address - Phone:509-888-8088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-05
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty