Individual provider Active NPI

Amy E. Wendling, D.D.S.

  • General Practice Dentistry
  • Warren, MI
National Provider Identifier
1679670772
Registry record updated Apr 12, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
29-01019392 Issued in MI
Practice address
13403 E 13 Mile Rd
Warren, MI 48088-3188
Phone
(586) 979-2800
Fax
(203) 880-1361
NPI assigned
Sep 20, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 12, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 29-01019392 MI Primary

Addresses

Primary practice location

13403 E 13 Mile Rd
Warren, MI 48088-3188

Mailing address

13403 E 13 Mile Rd
Warren, MI 48088-3188
Phone (586) 979-2800

Other identifiers 1

IdentifierTypeStateIssuer
4900750MedicaidMI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160413001424 MI Order and Referring Only - DentistPractitioner - Dentist 9537467238

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
29-01019392MIMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1460419200000",
    "number": "1679670772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13403 E 13 MILE RD",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480883188",
            "telephone_number": "586-979-2800",
            "fax_number": "203-880-1361"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13403 E 13 MILE RD",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480883188",
            "telephone_number": "586-979-2800",
            "fax_number": "203-880-1361"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WENDLING",
        "first_name": "AMY",
        "middle_name": "E.",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-20",
        "last_updated": "2016-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "29-01019392",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4900750",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Warren, MI

Sources for this page

Verify at the official NPI Registry.