Provider Demographics
NPI:1104991835
Name:WENDEL, ROBERT GERALD (DMD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:GERALD
Last Name:WENDEL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12121 E BROADWAY AVE
Mailing Address - Street 2:BLDG II
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-4972
Mailing Address - Country:US
Mailing Address - Phone:509-924-1314
Mailing Address - Fax:509-924-1348
Practice Address - Street 1:12121 E BROADWAY AVE
Practice Address - Street 2:BLDG II
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-4972
Practice Address - Country:US
Practice Address - Phone:509-924-1314
Practice Address - Fax:509-924-1348
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00004414122300000X
ORD4889122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist