NPIMap

Organization Active NPI

Wandell Dental Corporation

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Ukiah, CA
National Provider Identifier
1407601164
Registry record updated Apr 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X
Legal business name
WANDELL DENTAL CORPORATION
Practice address
620 S Dora St Ste 205
Ukiah, CA 95482-5482
Phone
(707) 462-6983
Fax
(707) 462-6984
NPI assigned
Apr 17, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Adam Joshua Farrell Wandell, DDS, MDNPI 1871021709
Title
Owner
Phone
(650) 714-3694

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral & Maxillofacial Surgery (D.M.D.)Group: 193400000X SINGLE SPECIALTY GROUP 204E00000X Primary

Addresses

Primary practice location

620 S Dora St Ste 205
Ukiah, CA 95482-5482

Mailing address

620 S Dora St Ste 205
Ukiah, CA 95482-5482
Phone (707) 462-6983

Other practice location 1

445 March Ave Ste B
Healdsburg, CA 95448-3383
Phone (707) 433-0231

Other names 2

  • Healdsburg Oral Surgery & Dental Implants Doing business as
  • Ukiah Oral Surgery & Dental Implants Doing business as

National Provider Directory

National Provider Directory

Locations

445 March Ave
Ste B
Healdsburg, CA 95448
Phone (650) 714-3694

620 S Dora St
Ste 205
Ukiah, CA 95482
Phone (707) 462-6938

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1713312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713312000000",
    "number": "1407601164",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "620 S DORA ST STE 205",
            "city": "UKIAH",
            "state": "CA",
            "postal_code": "954825482",
            "telephone_number": "707-462-6983",
            "fax_number": "707-462-6984"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 S DORA ST STE 205",
            "city": "UKIAH",
            "state": "CA",
            "postal_code": "954825482",
            "telephone_number": "707-462-6983",
            "fax_number": "707-462-6984"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "445 March Ave Ste B",
            "address_purpose": "LOCATION",
            "city": "Healdsburg",
            "state": "CA",
            "postal_code": "954483383",
            "country_code": "US",
            "telephone_number": "707-433-0231",
            "fax_number": "707-433-0238",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "WANDELL DENTAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-17",
        "last_updated": "2024-04-17",
        "certification_date": "2024-04-17",
        "status": "A",
        "authorized_official_last_name": "WANDELL",
        "authorized_official_first_name": "ADAM",
        "authorized_official_middle_name": "JOSHUA FARRELL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "650-714-3694",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS, MD"
    },
    "taxonomies": [
        {
            "code": "204E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Oral & Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Healdsburg Oral Surgery & Dental Implants",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Ukiah Oral Surgery & Dental Implants",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ukiah, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.