Individual provider Active NPI

James Marcus Wenninger, DMD

  • General Practice Dentistry
  • Crestwood, KY
National Provider Identifier
1942317169
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
Y301 Issued in KY
Practice address
5805 W Highway 22
Crestwood, KY 40014-7244
Phone
(502) 241-9407
Fax
(502) 241-9407
NPI assigned
Aug 24, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X Y301 KY
General Practice Dentistry 1223G0001X Y301 KY Primary

Addresses

Primary practice location

5805 W Highway 22
Crestwood, KY 40014-7244

Mailing address

5805 W Highway 22
Crestwood, KY 40014-7244
Phone (502) 241-9407

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
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
I20150501001773 KY Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 2466771035

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
Y301KYMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
University Physicians Group - Radiology Past Accepting new patients
Alan R Gould DDS Ms LLC PastSince Jan 1, 2004 Accepting new patients

Organizations & group practices 2

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": "1156377600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757548800000",
    "number": "1942317169",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5805 W HIGHWAY 22",
            "city": "CRESTWOOD",
            "state": "KY",
            "postal_code": "400147244",
            "telephone_number": "502-241-9407",
            "fax_number": "502-241-2339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5805 W HIGHWAY 22",
            "city": "CRESTWOOD",
            "state": "KY",
            "postal_code": "400147244",
            "telephone_number": "502-241-9407",
            "fax_number": "502-241-9407"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WENNINGER",
        "first_name": "JAMES",
        "middle_name": "MARCUS",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-24",
        "last_updated": "2025-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "KY",
            "license": "Y301",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "KY",
            "license": "Y301",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Crestwood, KY

Sources for this page

Verify at the official NPI Registry.