Active NPI
Jeffrey Raymond Wnuk, D.M.D.
- Dentist
- Boston, MA
National Provider Identifier
1053692814
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DL11206
- Practice address
- 1340 Boylston St
Boston, MA 02215-4302 - Phone
- (617) 927-6127
- Fax
- (617) 927-6150
- NPI assigned
- Sep 7, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DL11206 | MA | Primary |
Addresses
Primary practice location
1340 Boylston St
Boston, MA 02215-4302
Mailing address
1340 Boylston St
Boston, MA 02215-4302
Phone (617) 927-6127
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 110020739B | Medicaid | MA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DL11206 | MA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1315353600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1315353600000",
"number": "1053692814",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1340 BOYLSTON ST",
"city": "BOSTON",
"state": "MA",
"postal_code": "022154302",
"telephone_number": "617-927-6127",
"fax_number": "617-927-6150"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1340 BOYLSTON ST",
"city": "BOSTON",
"state": "MA",
"postal_code": "022154302",
"telephone_number": "617-927-6127",
"fax_number": "617-927-6150"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WNUK",
"first_name": "JEFFREY",
"middle_name": "RAYMOND",
"name_prefix": "Dr.",
"credential": "D.M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-09-07",
"last_updated": "2011-09-07",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MA",
"license": "DL11206",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "110020739B",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Boston, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.