Kory K Wegner

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

4301WI Issued in WI

Practice address

105 E Silver Spring Dr
Whitefish Bay, WI 53217-4702

Phone

(414) 964-0680

Fax

(414) 964-0682

NPI assigned

Jan 25, 2007

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

Enrolled in WI

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1169683200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1487700571",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1803 E JUNIPER WAY",
            "city": "HARTLAND",
            "state": "WI",
            "postal_code": "530298672",
            "telephone_number": "262-367-7441",
            "fax_number": "414-964-0682"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 E SILVER SPRING DR",
            "city": "WHITEFISH BAY",
            "state": "WI",
            "postal_code": "532174702",
            "telephone_number": "414-964-0680",
            "fax_number": "414-964-0682"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEGNER",
        "first_name": "KORY",
        "middle_name": "K",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-25",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "4301WI",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Meda A. Tutila, PHARMD
• Jan C Van Schaik, MD
• Erika Veal, R.N.
• George Vukmir, D.D.S.
• Cameron J Wagner, DMD
• Lizhi Wei, L.AC., DIPL. AC.
• Brandon A Wells, M.S., LPC
• Elinor Rose Werner
• Trevor Wesline, DPT
• Claire Whetter, LPC

• General Practice Dentistry in Whitefish Bay, WI
• Providers in Whitefish Bay, 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 Jul 8, 2007; 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.