Individual
TODD WENTLAND
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1500 S MAIN ST, FORT WORTH, TX 76104-4917
(858) 774-8117
Mailing address
1500 S MAIN ST, FORT WORTH, TX 76104-4917
(858) 774-8117
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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