Kenneth Orlando Wynn, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

DN0S11664 Issued in GA

Practice address

United States Milityary Academy
Dentac, 646 Swift Road
West Point, NY 10996-1905

Phone

(845) 938-4212

Fax

(845) 938-4302

NPI assigned

Oct 12, 2006

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

Enrolled in FL

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

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1160611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1972692192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "UNITED STATES MILITYARY ACADEMY",
            "address_2": "DENTAC, 646 SWIFT ROAD",
            "city": "WEST POINT",
            "state": "NY",
            "postal_code": "109961905",
            "telephone_number": "845-938-4212",
            "fax_number": "845-938-4302"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "UNITED STATES MILITYARY ACADEMY",
            "address_2": "DENTAC, 646 SWIFT ROAD",
            "city": "WEST POINT",
            "state": "NY",
            "postal_code": "109961905",
            "telephone_number": "845-938-4212",
            "fax_number": "845-938-4302"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYNN",
        "first_name": "KENNETH",
        "middle_name": "ORLANDO",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-12",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "GA",
            "license": "DN0S11664",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Donna Wiener-Levy, PH.D.
• Vanessa Williamson, LISW
• John E. Wilson Jr., CRNA
• Kaitlynn Winchell
• Becky Wiza, RD
• Amy Yavorek, MD
• Trudy A Yavorek, M.D.
• Levi Young, AU.D.

• Dentist in West Point, NY
• Providers in West Point, NY by specialty
• Dentist in New York

• 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.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.