Individual
DR. WENDELL ALAN EDGIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
4499 MEDICAL DR, SUITE 190, SAN ANTONIO, TX 78229-3735
(210) 614-3916
(210) 614-3918
Mailing address
4499 MEDICAL DR, SUITE 190, SAN ANTONIO, TX 78229-3735
(210) 614-3916
(210) 614-3918
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
12355
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
141763601
—
TX
05
—
141763604
—
TX
Enumeration date
07/22/2005
Last updated
02/28/2008
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