Individual
TODD WENTLAND
Active
Individual
TODD WENTLAND
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
35058
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
35058
DDS LICENSE
TX
01
—
S0589
MD LICENSE
TX
Enumeration date
03/18/2013
Last updated
06/12/2019
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