Kenneth John Wendorf, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

5001665 Issued in WI

Practice address

3220 80TH St
Kenosha, WI 53142-4948

Phone

(252) 694-8500

NPI assigned

Jun 3, 2008

Sex

Male

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1212451200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1212451200000",
    "number": "1215196563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3220 80TH ST",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531424948",
            "telephone_number": "252-694-8500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3220 80TH ST",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531424948",
            "telephone_number": "252-694-8500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WENDORF",
        "first_name": "KENNETH",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-06-03",
        "last_updated": "2008-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "5001665",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sheila M Weis, PA-C
• Zachary Alan Weis, MS
• Linda G Weiss, APNP
• Kelsey Anne Welch, ATC
• Michael M Welch, LCSW
• Tarey Ann Wenninger, P.T.,
• Thomas S Werbie, M.D.
• Jaclyn K Weston, PT
• Cathy Ann Westover, P.T.
• James M. Westover, MA, LPC

• General Practice Dentistry in Kenosha, WI
• Providers in Kenosha, WI by specialty
• General Practice Dentistry in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 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.

Verify at the official NPI Registry.