Provider Demographics
NPI:1972692192
Name:WYNN, KENNETH ORLANDO (DMD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:ORLANDO
Last Name:WYNN
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:UNITED STATES MILITYARY ACADEMY
Mailing Address - Street 2:DENTAC, 646 SWIFT ROAD
Mailing Address - City:WEST POINT
Mailing Address - State:NY
Mailing Address - Zip Code:10996-1905
Mailing Address - Country:US
Mailing Address - Phone:845-938-4212
Mailing Address - Fax:845-938-4302
Practice Address - Street 1:UNITED STATES MILITYARY ACADEMY
Practice Address - Street 2:DENTAC, 646 SWIFT ROAD
Practice Address - City:WEST POINT
Practice Address - State:NY
Practice Address - Zip Code:10996-1905
Practice Address - Country:US
Practice Address - Phone:845-938-4212
Practice Address - Fax:845-938-4302
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0S11664122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist