Individual provider Active NPI

Kenneth John Wolnik II, D.D.S.

  • General Practice Dentistry
  • Parma Heights, OH
National Provider Identifier
1780896118
Registry record updated Oct 3, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
21692 Issued in OH
Practice address
6363 York Rd
Suite 202
Parma Heights, OH 44130-3031
Phone
(440) 888-5055
Fax
(440) 888-0249
NPI assigned
May 6, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 3, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 21692 OH Primary

Addresses

Primary practice location

6363 York Rd
Suite 202
Parma Heights, OH 44130-3031

Mailing address

6363 York Rd
Suite 202
Parma Heights, OH 44130-3031
Phone (440) 888-5055

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150514002098 OH Order and Referring Only - DentistPractitioner - Dentist 1052631074

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
21692OHMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Kenneth J. Wolnik, DDS Inc General Practice Past Accepting new patients

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1178409600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1412294400000",
    "number": "1780896118",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6363 YORK RD",
            "address_2": "SUITE 202",
            "city": "PARMA HEIGHTS",
            "state": "OH",
            "postal_code": "441303031",
            "telephone_number": "440-888-5055",
            "fax_number": "440-888-0249"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6363 YORK RD",
            "address_2": "SUITE 202",
            "city": "PARMA HEIGHTS",
            "state": "OH",
            "postal_code": "441303031",
            "telephone_number": "440-888-5055",
            "fax_number": "440-888-0249"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOLNIK",
        "first_name": "KENNETH",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "name_suffix": "II",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-06",
        "last_updated": "2014-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OH",
            "license": "21692",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Parma Heights, OH

Sources for this page

Verify at the official NPI Registry.