Provider Demographics
NPI:1730202300
Name:WARDLAW, WENDI (DDS)
Entity type:Individual
Prefix:DR
First Name:WENDI
Middle Name:
Last Name:WARDLAW
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15502 STONEYBROOK WEST PKWY
Mailing Address - Street 2:SUITE 126
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-4767
Mailing Address - Country:US
Mailing Address - Phone:407-380-7779
Mailing Address - Fax:407-641-9019
Practice Address - Street 1:15502 STONEYBROOK WEST PKWY
Practice Address - Street 2:SUITE 126
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-4767
Practice Address - Country:US
Practice Address - Phone:407-380-7779
Practice Address - Fax:407-641-9019
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN172911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice