Kathryn Susanne Wynne, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

DD5155 Issued in NM

Practice address

5131 Main St Ste 101
Santa Fe, NM 87507-2682

Phone

(505) 209-9080

NPI assigned

Jul 31, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NM

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Santa Fe Dentist Office, LLC

  dba Santa Fe Dentist Office

  • General Practice Dentistry
  • Santa Fe, NM
  • NPI 1982062048
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1564531200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1564531200000",
    "number": "1073167789",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5327 CAMINO DEL GRIEGO",
            "city": "SANTA FE",
            "state": "NM",
            "postal_code": "87507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5131 MAIN ST STE 101",
            "city": "SANTA FE",
            "state": "NM",
            "postal_code": "875072682",
            "telephone_number": "505-209-9080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYNNE",
        "first_name": "KATHRYN",
        "middle_name": "SUSANNE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-07-31",
        "last_updated": "2019-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NM",
            "license": "DD5155",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rebecca M. Wright, MA LPCC
• Tahoma Wrubleski
• Philip Richard Wyatt, M.D.
• Christopher Robert Charles Wyndham, MD
• Andrea Leigh Wynn
• Ying Xiong, CRNA
• Alyson Yacono, DPT, PT, CERT. DN
• Donna Yactor, SLP
• Caroline Naomi Yamashiro
• Katharine S Yanda, MPH, OTR/L

• Dentist in Santa Fe, NM
• Providers in Santa Fe, NM by specialty
• Dentist in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.