Active NPI
Christopher Smith Wennerholm
- Dental Anesthesiology
- Gilbert, AZ
National Provider Identifier
1083364293
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Anesthesiology
- License
- D012421
- Practice address
- 2308 E Bonita St
Gilbert, AZ 85296-2743 - Phone
- (480) 204-9392
- NPI assigned
- Mar 29, 2022
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Anesthesiology | 1223D0004X | D012421 | AZ | Primary |
| Student in an Organized Health Care Education/Training Program | 390200000X |
Addresses
Primary practice location
2308 E Bonita St
Gilbert, AZ 85296-2743
Mailing address
2308 E Bonita St
Gilbert, AZ 85296-2743
Phone (480) 204-9392
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 |
|---|---|---|---|
| D012421 | AZ | MD | Dentist Anesthesiologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1648512000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1769126400000",
"number": "1083364293",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2308 E BONITA ST",
"city": "GILBERT",
"state": "AZ",
"postal_code": "852962743",
"telephone_number": "480-204-9392"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2308 E BONITA ST",
"city": "GILBERT",
"state": "AZ",
"postal_code": "852962743",
"telephone_number": "480-204-9392"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WENNERHOLM",
"first_name": "CHRISTOPHER",
"middle_name": "SMITH",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-03-29",
"last_updated": "2026-01-23",
"certification_date": "2026-01-23",
"status": "A"
},
"taxonomies": [
{
"code": "1223D0004X",
"taxonomy_group": "",
"desc": "Dentist, Dental Anesthesiology",
"state": "AZ",
"license": "D012421",
"primary": true
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gilbert, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.