Provider Demographics
NPI:1427285246
Name:RACETTE, WENDELL ALAN (DDS)
Entity type:Individual
Prefix:DR
First Name:WENDELL
Middle Name:ALAN
Last Name:RACETTE
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 1:5915 OLD OAK CT
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-5119
Mailing Address - Country:US
Mailing Address - Phone:517-886-1312
Mailing Address - Fax:
Practice Address - Street 1:117 S KINNEY AVE
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-2702
Practice Address - Country:US
Practice Address - Phone:989-773-2133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-18
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010100201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice