Provider Demographics
NPI:1588979587
Name:BEYER, WENDY (RDH)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:BEYER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:
Other - Last Name:OLTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:E7450 LITTLE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:MANAWA
Mailing Address - State:WI
Mailing Address - Zip Code:54949-8824
Mailing Address - Country:US
Mailing Address - Phone:920-538-0204
Mailing Address - Fax:
Practice Address - Street 1:E7450 LITTLE CREEK RD
Practice Address - Street 2:
Practice Address - City:MANAWA
Practice Address - State:WI
Practice Address - Zip Code:54949-8824
Practice Address - Country:US
Practice Address - Phone:920-538-0204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-13
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5980-016124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist