Kenneth W Wyman II

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

UNKNOWN Issued in AK

Practice address

1225 Well St
Fairbanks, AK 99701-2836

Phone

(907) 456-6850

Fax

(907) 456-7510

NPI assigned

Apr 21, 2008

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

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": "1208736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1208736000000",
    "number": "1427222405",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 80299",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997080299",
            "telephone_number": "907-457-8739",
            "fax_number": "907-456-7510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1225 WELL ST",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997012836",
            "telephone_number": "907-456-6850",
            "fax_number": "907-456-7510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYMAN",
        "first_name": "KENNETH",
        "middle_name": "W",
        "name_prefix": "Mr.",
        "name_suffix": "II",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-04-21",
        "last_updated": "2008-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "AK",
            "license": "UNKNOWN",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "AK",
            "license": "UNKNOWN",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "AK",
            "license": "UNKNOWN",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Glenn Wrightsman
• Bovey Jingzhu Wu, DO
• Glenn Eduard Christiane Wuyts
• WW Enterprise, LLC
• Monica Wyatt, RN
• Shannon R. Wyman, D.C.
• Brian Edward Yamamoto, DDS
• Leslie Yamamoto, LCSW
• Fusheng Jonathan Yang
• Brionna Leigh Yannello

• Oral and Maxillofacial Surgery (Dentist) in Fairbanks, AK
• Providers in Fairbanks, AK by specialty
• Oral and Maxillofacial Surgery (Dentist) in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 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.