Provider Demographics
NPI:1841175528
Name:MINELLI, WENDY
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:MINELLI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27183 CLEAR LAKE DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48051-1692
Mailing Address - Country:US
Mailing Address - Phone:586-405-3118
Mailing Address - Fax:586-405-3118
Practice Address - Street 1:27690 VAN DYKE AVE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-2842
Practice Address - Country:US
Practice Address - Phone:586-465-8070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-11
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI21223020801124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist