Provider Demographics
NPI:1487693198
Name:WENGER, ABRAHAM (DMD)
Entity type:Individual
Prefix:
First Name:ABRAHAM
Middle Name:
Last Name:WENGER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1341 NORTH AVE
Mailing Address - Street 2:APT 5-EF
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07208-2622
Mailing Address - Country:US
Mailing Address - Phone:908-820-0194
Mailing Address - Fax:
Practice Address - Street 1:142 PALISADE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07208-1104
Practice Address - Country:US
Practice Address - Phone:201-798-5551
Practice Address - Fax:201-798-1171
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI 230121851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0650501Medicaid