Kenneth B Weddell PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D12619 Issued in MN

Legal business name

KENNETH B WEDDELL PLLC

Practice address

8900 Penn Ave S Ste 211
Bloomington, MN 55431-2068

Phone

(952) 884-7706

Fax

(952) 881-6006

NPI assigned

Sep 7, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Kenneth Bruce Weddell, DDSNPI 1104884147

Title

Owner

Phone

(952) 884-7706

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kenneth Bruce Weddell, DDS

  • Dentist
  • Fremont, MI
  • NPI 1104884147

  MN

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1346976000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1691539200000",
    "number": "1073862819",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8900 PENN AVE S STE 211",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554312068",
            "telephone_number": "952-884-7706",
            "fax_number": "952-881-6006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8900 PENN AVE S STE 211",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554312068",
            "telephone_number": "952-884-7706",
            "fax_number": "952-881-6006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENNETH B WEDDELL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-07",
        "last_updated": "2023-08-09",
        "certification_date": "2023-08-09",
        "status": "A",
        "authorized_official_last_name": "WEDDELL",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "BRUCE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "952-884-7706",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D12619",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1104884147",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shelley Marie Kelly
• Dennis Kelner
• Alglozia Kenyetta - Patrece Kennedy
• Honora E. Kennedy, M.D.
• Shemarah M Kennedy
• Allen Dennis Kenny
• Hannah Kent
• Mary R Kerr, NP
• Katelin Kes, OTR/L
• Nadia Kewden

• General Practice Dentistry in Bloomington, MN
• Providers in Bloomington, MN by specialty
• General Practice Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.