Provider Demographics
NPI:1366117467
Name:BOTSCH, WENDY M (RDH)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:M
Last Name:BOTSCH
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1704 9TH RD
Mailing Address - Street 2:
Mailing Address - City:CHAPMAN
Mailing Address - State:NE
Mailing Address - Zip Code:68827-2713
Mailing Address - Country:US
Mailing Address - Phone:402-450-9117
Mailing Address - Fax:
Practice Address - Street 1:2602 18TH AVE
Practice Address - Street 2:
Practice Address - City:CENTRAL CITY
Practice Address - State:NE
Practice Address - Zip Code:68826-9761
Practice Address - Country:US
Practice Address - Phone:308-946-3059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-11
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2127124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist