Provider Demographics
NPI:1194344846
Name:WETTENGEL, JEFFREY (DDS)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:WETTENGEL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 CARTHAGE ST
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27330-4108
Mailing Address - Country:US
Mailing Address - Phone:757-816-8038
Mailing Address - Fax:
Practice Address - Street 1:703 CARTHAGE ST
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-4108
Practice Address - Country:US
Practice Address - Phone:757-816-8038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-13
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12945122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC12945OtherNC DENTAL BOARD