Provider Demographics
NPI:1316726300
Name:DEHRAB, WENDY KRISTINE (RDH)
Entity type:Individual
Prefix:MS
First Name:WENDY
Middle Name:KRISTINE
Last Name:DEHRAB
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:KRISTINE
Other - Last Name:LONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:1528 INDIA ST APT 106
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-2498
Mailing Address - Country:US
Mailing Address - Phone:858-262-1509
Mailing Address - Fax:
Practice Address - Street 1:3177 OCEAN VIEW BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92113-1432
Practice Address - Country:US
Practice Address - Phone:619-662-4100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-27
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18180124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty