Active NPI
David Calvin Wentz, DDS
- General Practice Dentistry
- Moorhead, MN
National Provider Identifier
1194841916
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 8274
- Practice address
- 320 2ND Ave S
Suite 106
Moorhead, MN 56560-2602 - Phone
- (218) 236-1666
- Fax
- (218) 236-0543
- NPI assigned
- Mar 22, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 8274 | MN | Primary |
Addresses
Primary practice location
320 2ND Ave S
Suite 106
Moorhead, MN 56560-2602
Mailing address
320 2ND Ave S
Suite 106
Moorhead, MN 56560-2602
Phone (218) 236-1666
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 411388621 | Other | MN | TAX IDENTFICATION NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8274 | MN | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jessica L. Hardy, DDS, PA | General Practice | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Practice Dentistry
- Moorhead, MN
- NPI 1174906911
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174521600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1194841916",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "320 2ND AVE S",
"address_2": "SUITE 106",
"city": "MOORHEAD",
"state": "MN",
"postal_code": "565602602",
"telephone_number": "218-236-1666",
"fax_number": "219-236-0543"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "320 2ND AVE S",
"address_2": "SUITE 106",
"city": "MOORHEAD",
"state": "MN",
"postal_code": "565602602",
"telephone_number": "218-236-1666",
"fax_number": "218-236-0543"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WENTZ",
"first_name": "DAVID",
"middle_name": "CALVIN",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-22",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MN",
"license": "8274",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TAX IDENTFICATION NUMBER",
"identifier": "411388621",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Moorhead, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.