Kenneth Ray Wiedenfeld, D.D.S.

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

14144 Issued in TX

Practice address

101 Professional Park Dr
Victoria, TX 77904-2351

Phone

(361) 578-8800

Fax

(361) 575-6986

NPI assigned

Aug 10, 2006

Last updated

Jul 8, 2007By the provider in NPPES

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

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Victoria Kids Dentistry PLLC

  dba Dr. Wiedenfeld DDS- Children's Dentistry

  • Pediatric Dentistry
  • Victoria, TX
  • NPI 1861910341
  NPD (past)

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

{
    "created_epoch": "1155168000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1568473189",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 PROFESSIONAL PARK DR",
            "city": "VICTORIA",
            "state": "TX",
            "postal_code": "779042351",
            "telephone_number": "361-578-8800",
            "fax_number": "361-575-6986"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 PROFESSIONAL PARK DR",
            "city": "VICTORIA",
            "state": "TX",
            "postal_code": "779042351",
            "telephone_number": "361-578-8800",
            "fax_number": "361-575-6986"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIEDENFELD",
        "first_name": "KENNETH",
        "middle_name": "RAY",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-10",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "TX",
            "license": "14144",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Delores Evens White, LPC
• Richard Christian White, OD
• Kristina Alexis Whiteley
• Brenda Ellen Whitfield, L.P.C., R.P.T.
• Kelly Michele Whitson, FNP-C
• Marshall Wiener, M.D.
• Nikki Marie Wilborn, NNP
• Charla Gay Wilhelm, R.N.
• William B. Shay, M.D., P.a.
• Darlyn Williams, APRN

• Pediatric Dentistry in Victoria, TX
• Providers in Victoria, TX by specialty
• Pediatric Dentistry in Texas

• 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.