Provider Demographics
NPI:1699727610
Name:WEDNER, IRWIN JEROME (DDS)
Entity type:Individual
Prefix:DR
First Name:IRWIN
Middle Name:JEROME
Last Name:WEDNER
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 1:1321 N HARBOR BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-4124
Mailing Address - Country:US
Mailing Address - Phone:714-879-0085
Mailing Address - Fax:714-879-6260
Practice Address - Street 1:1321 N HARBOR BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-4124
Practice Address - Country:US
Practice Address - Phone:714-879-0085
Practice Address - Fax:714-879-6260
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA199871223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics