Charles Bernard Wenner, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D14635 Issued in MN

Practice address

250 Fuller St S
Shakopee, MN 55379-1323

Phone

(952) 445-6657

NPI assigned

Jul 14, 2021

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

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.

• O'Brien Dental Care

  • General Practice Dentistry
  • Shakopee, MN
  • NPI 1710086459
  Medicare reassignment NPD

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

{
    "created_epoch": "1626220800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626220800000",
    "number": "1437721982",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18394 GLENWOOD RD",
            "city": "RICHMOND",
            "state": "MN",
            "postal_code": "563688123",
            "telephone_number": "320-333-1719"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 FULLER ST S",
            "city": "SHAKOPEE",
            "state": "MN",
            "postal_code": "553791323",
            "telephone_number": "952-445-6657"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WENNER",
        "first_name": "CHARLES",
        "middle_name": "BERNARD",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-07-14",
        "last_updated": "2021-07-14",
        "certification_date": "2021-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D14635",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tawnya Ward
• Halimo Hassan Warsame
• Katelyn Rose Weckwerth
• Brianna Weiland
• Joelle Elise Weir, CNP
• Brittany Werre, LICSW
• Mark Westholder
• Ann Elizabeth Williams, DC
• Bruce Mosby Williams, D.D.S
• Danelle Williams, MSW LICSW

• General Practice Dentistry in Shakopee, MN
• Providers in Shakopee, 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 Jul 14, 2021; 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.