Active NPI
Damian O. Fennig, D.D.S.
- Orthodontics and Dentofacial Orthopedics Dentistry
- Madison, WI
National Provider Identifier
1942358635
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- 5001564
- Practice address
- 5520 Medical Cir
Madison, WI 53719-1226 - Phone
- (608) 274-5714
- Fax
- (608) 274-0591
- NPI assigned
- Jan 8, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 5001564 | WI | Primary |
Addresses
Primary practice location
5520 Medical Cir
Madison, WI 53719-1226
Mailing address
5520 Medical Cir
Madison, WI 53719-1226
Phone (608) 274-5714
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5001564 | WI | MD | Orthodontics and Dentofacial Orthopedic Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168214400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1942358635",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5520 MEDICAL CIR",
"city": "MADISON",
"state": "WI",
"postal_code": "537191226",
"telephone_number": "608-274-5714",
"fax_number": "608-274-0591"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5520 MEDICAL CIR",
"city": "MADISON",
"state": "WI",
"postal_code": "537191226",
"telephone_number": "608-274-5714",
"fax_number": "608-274-0591"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FENNIG",
"first_name": "DAMIAN",
"middle_name": "O.",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-08",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "WI",
"license": "5001564",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Madison, WI
Sources for this page
- 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.