Provider Demographics
NPI:1316957673
Name:GLORIA WENGERT DDS PC
Entity type:Organization
Organization Name:GLORIA WENGERT DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:H
Authorized Official - Last Name:WENGERT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS FAGD
Authorized Official - Phone:505-833-1550
Mailing Address - Street 1:3803 ARTISCO DR NW
Mailing Address - Street 2:#D
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120
Mailing Address - Country:US
Mailing Address - Phone:505-833-1550
Mailing Address - Fax:505-831-8726
Practice Address - Street 1:3803 ARTISCO DR NW
Practice Address - Street 2:#D
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120
Practice Address - Country:US
Practice Address - Phone:505-833-1550
Practice Address - Fax:505-831-8726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM13681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty