Provider Demographics
NPI:1942317169
Name:WENNINGER, JAMES MARCUS (DMD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:MARCUS
Last Name:WENNINGER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5805 W HIGHWAY 22
Mailing Address - Street 2:
Mailing Address - City:CRESTWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:40014-7244
Mailing Address - Country:US
Mailing Address - Phone:502-241-9407
Mailing Address - Fax:502-241-2339
Practice Address - Street 1:5805 W HIGHWAY 22
Practice Address - Street 2:
Practice Address - City:CRESTWOOD
Practice Address - State:KY
Practice Address - Zip Code:40014-7244
Practice Address - Country:US
Practice Address - Phone:502-241-9407
Practice Address - Fax:502-241-9407
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYY301122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223G0001XDental ProvidersDentistGeneral Practice