Provider Demographics
NPI:1427046606
Name:WENDT, ROBERT DEAN (DDS)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:DEAN
Last Name:WENDT
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 1:1554A BRENTWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-3239
Mailing Address - Country:US
Mailing Address - Phone:631-666-4114
Mailing Address - Fax:631-666-4159
Practice Address - Street 1:1554A BRENTWOOD RD
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-3239
Practice Address - Country:US
Practice Address - Phone:631-666-4114
Practice Address - Fax:631-666-4159
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0454551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01951995Medicaid