Provider Demographics
NPI:1215958541
Name:W. WILLIAM WENTZ, JR., DDS, PC & HERBERT C. MANRY, DDS, PC
Entity type:Organization
Organization Name:W. WILLIAM WENTZ, JR., DDS, PC & HERBERT C. MANRY, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:C
Authorized Official - Last Name:MCVAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-792-5134
Mailing Address - Street 1:501 RISON ST STE 110
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-2458
Mailing Address - Country:US
Mailing Address - Phone:434-792-5134
Mailing Address - Fax:434-791-2919
Practice Address - Street 1:501 RISON ST STE 110
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-2458
Practice Address - Country:US
Practice Address - Phone:434-792-5134
Practice Address - Fax:434-791-2919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA=========OtherTAX ID