Provider Demographics
NPI:1386792463
Name:WENTZ, TODD ZANE (DDS, MS)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:ZANE
Last Name:WENTZ
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99709-3646
Mailing Address - Country:US
Mailing Address - Phone:907-452-7223
Mailing Address - Fax:907-452-1293
Practice Address - Street 1:701 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-3646
Practice Address - Country:US
Practice Address - Phone:907-452-7223
Practice Address - Fax:907-452-1293
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK8471223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics