Provider Demographics
NPI:1962590877
Name:WENDT, STEPHEN V (MD DDS)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:V
Last Name:WENDT
Suffix:
Gender:M
Credentials:MD DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1437 E 23RD ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68025-2433
Mailing Address - Country:US
Mailing Address - Phone:402-721-3600
Mailing Address - Fax:
Practice Address - Street 1:13215 BIRCH DR
Practice Address - Street 2:SUITE 100
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68164-5431
Practice Address - Country:US
Practice Address - Phone:402-390-0770
Practice Address - Fax:402-397-1074
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE182521223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47052802413Medicaid
NE47052802413Medicaid