Provider Demographics
NPI:1548515117
Name:WENK, BRIAN (DMD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:
Last Name:WENK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 S 333RD ST
Mailing Address - Street 2:SUITE C100
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-7363
Mailing Address - Country:US
Mailing Address - Phone:253-970-3390
Mailing Address - Fax:
Practice Address - Street 1:5322 GALLEON DR NE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98422-1924
Practice Address - Country:US
Practice Address - Phone:253-970-3390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-19
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60294200122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist