Active NPI
Brett Michael Wonenberg, DDS
- General Practice Dentistry
- Fortuna, CA
National Provider Identifier
1073783163
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 49706
- Practice address
- 1730 Main St
Suite a
Fortuna, CA 95540-2451 - Phone
- (707) 725-1303
- Fax
- (707) 725-1358
- NPI assigned
- Mar 5, 2008
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 49706 | CA | Primary |
Addresses
Primary practice location
1730 Main St
Suite a
Fortuna, CA 95540-2451
Mailing address
1730 Main St
Suite a
Fortuna, CA 95540-2451
Phone (707) 725-1303
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1204675200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1204675200000",
"number": "1073783163",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1730 MAIN ST",
"address_2": "SUITE A",
"city": "FORTUNA",
"state": "CA",
"postal_code": "955402451",
"telephone_number": "707-725-1303",
"fax_number": "707-725-1358"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1730 MAIN ST",
"address_2": "SUITE A",
"city": "FORTUNA",
"state": "CA",
"postal_code": "955402451",
"telephone_number": "707-725-1303",
"fax_number": "707-725-1358"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WONENBERG",
"first_name": "BRETT",
"middle_name": "MICHAEL",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-03-05",
"last_updated": "2008-03-05",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "49706",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fortuna, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.