Provider Demographics
NPI:1215779947
Name:BENDER, WYNETTE (DMD)
Entity type:Individual
Prefix:DR
First Name:WYNETTE
Middle Name:
Last Name:BENDER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3308 MONTICELLO BLVD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-1318
Mailing Address - Country:US
Mailing Address - Phone:216-313-6748
Mailing Address - Fax:
Practice Address - Street 1:13990 CEDAR RD STE B
Practice Address - Street 2:
Practice Address - City:UNIVERSITY HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44118-3200
Practice Address - Country:US
Practice Address - Phone:216-395-7336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-12
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0276131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty