Provider Demographics
NPI:1104992155
Name:BREITZMAN, WENDY MARIE (DDS)
Entity type:Individual
Prefix:DR
First Name:WENDY
Middle Name:MARIE
Last Name:BREITZMAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9149 CANDLEWOOD ST
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-1232
Mailing Address - Country:US
Mailing Address - Phone:909-476-8762
Mailing Address - Fax:
Practice Address - Street 1:7369 DAY CREEK BLVD STE F-103
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91739-8020
Practice Address - Country:US
Practice Address - Phone:909-646-7902
Practice Address - Fax:909-646-7903
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52833122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist