Provider Demographics
NPI:1285813303
Name:WENDELL, /PETER DAMON (DDS)
Entity type:Individual
Prefix:DR
First Name:/PETER
Middle Name:DAMON
Last Name:WENDELL
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 1:4097 IRONBOUND RD STE A
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-2676
Mailing Address - Country:US
Mailing Address - Phone:757-253-1200
Mailing Address - Fax:757-253-1255
Practice Address - Street 1:4097 IRONBOUND RD STE A
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-2676
Practice Address - Country:US
Practice Address - Phone:757-253-1200
Practice Address - Fax:757-253-1255
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-25
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010063601223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics