Provider Demographics
NPI:1558178673
Name:MAGANA, WENDY S (RDH)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:S
Last Name:MAGANA
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 1:6702 PARK GROVE BLVD
Mailing Address - Street 2:
Mailing Address - City:WHITESTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:46075-6208
Mailing Address - Country:US
Mailing Address - Phone:317-397-7583
Mailing Address - Fax:
Practice Address - Street 1:6702 PARK GROVE BLVD
Practice Address - Street 2:
Practice Address - City:WHITESTOWN
Practice Address - State:IN
Practice Address - Zip Code:46075-6208
Practice Address - Country:US
Practice Address - Phone:317-397-7583
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-12
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN89001506A124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist