Individual provider Active NPI

Henry B Wengelewski Jr., D.D.S.

  • General Practice Dentistry
  • Milwaukee, WI
National Provider Identifier
1952514846
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
3536 Issued in WI
Practice address
4410 W. Oklahoma Avenue
Milwaukee, WI 53219
Phone
(414) 545-0770
NPI assigned
May 7, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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 3536 WI Primary

Addresses

Primary practice location

4410 W. Oklahoma Avenue
Milwaukee, WI 53219

Mailing address

4410 W. Oklahoma Avenue
Milwaukee, WI 53219
Phone (414) 545-0770

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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
I20150611001725 WI Order and Referring Only - DentistPractitioner - Dentist 6507187846

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3536WIMDPhysician Assistant

NPI Registry JSON

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

{
    "created_epoch": "1178496000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1952514846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4410 W. OKLAHOMA AVENUE",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "53219",
            "telephone_number": "414-545-0770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4410 W. OKLAHOMA AVENUE",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "53219",
            "telephone_number": "414-545-0770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WENGELEWSKI",
        "first_name": "HENRY",
        "middle_name": "B",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-07",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "3536",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

Verify at the official NPI Registry.