Kenneth Bruce Weddell, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

14503 Issued in MI

Practice address

111 W Dayton St
Fremont, MI 49412

Phone

(231) 924-3600

Fax

(231) 924-9720

NPI assigned

May 1, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MN

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

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Kenneth B Weddell PLLC

  • General Practice Dentistry
  • Bloomington, MN
  • NPI 1073862819
  Medicare reassignment NPD Authorized official
• Kenneth B Weddell DDS PC

  • Dentist
  • Fremont, MI
  • NPI 1730161175
  NPD (past) Authorized official
• Walter I. Coleman, DDS, PLLC

  • Dental Clinic/Center
  • Fremont, MI
  • NPI 1568777290
  NPD (past)

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

{
    "created_epoch": "1146441600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1104884147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 W DAYTON ST",
            "address_2": "PO BOX 437",
            "city": "FREMONT",
            "state": "MI",
            "postal_code": "49412",
            "telephone_number": "231-924-3600",
            "fax_number": "231-924-9720"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 W DAYTON ST",
            "city": "FREMONT",
            "state": "MI",
            "postal_code": "49412",
            "telephone_number": "231-924-3600",
            "fax_number": "231-924-9720"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEDDELL",
        "first_name": "KENNETH",
        "middle_name": "BRUCE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-01",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "14503",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "D808140",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UN CONCORDIA",
            "identifier": "847376",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Benjamin Wallace, DDS
• Walter I. Coleman, DDS, PLLC
• Eric R Weaver, MD
• Angela Lynn Weber, LLC
• Kathleen Weber, RD
• Elizabeth J. Welsh, M.D.
• Stephen L. Welsh, M.D.
• West Michigan Heart
• Anthony Joseph-Lane White
• Dale Alan Wiersma, MD

• Dentist in Fremont, MI
• Providers in Fremont, MI by specialty
• Dentist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; 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.