Provider Demographics
NPI:1487499968
Name:WENK, KAYLA JEANETTE (DMD)
Entity type:Individual
Prefix:DR
First Name:KAYLA
Middle Name:JEANETTE
Last Name:WENK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5655 MAUNA LOA BLVD UNIT 210
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34240-7079
Mailing Address - Country:US
Mailing Address - Phone:561-289-1657
Mailing Address - Fax:
Practice Address - Street 1:1750 TAMIAMI TRL STE 100
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33948-1045
Practice Address - Country:US
Practice Address - Phone:941-235-1001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-27
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL29245122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist