Provider Demographics
NPI:1487780458
Name:VAN METER, WENDY HUMPHREY (DMD)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:HUMPHREY
Last Name:VAN METER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:K
Other - Last Name:HUMPHREY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:181 W LOWRY LN
Mailing Address - Street 2:SUITE 110
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-3016
Mailing Address - Country:US
Mailing Address - Phone:859-277-5437
Mailing Address - Fax:859-277-8827
Practice Address - Street 1:181 W LOWRY LN
Practice Address - Street 2:SUITE 110
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-3016
Practice Address - Country:US
Practice Address - Phone:859-277-5437
Practice Address - Fax:859-277-8827
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY7980122300000X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60002839Medicaid