Bruce Robert Wittenberg, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

9625 Issued in MN

Practice address

512 66TH Ave N
Brooklyn Center, MN 55430-1643

Phone

(763) 560-3334

NPI assigned

Mar 5, 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

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

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.

• Metro Dentalcare, PLC

  • Dentist
  • Lakeville, MN
  • NPI 1316913411
  NPD (past)
• Northland Dental Partners, PLLC

  • General Practice Dentistry
  • Brooklyn Center, MN
  • NPI 1497403810
  NPD (past)

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

{
    "created_epoch": "1141516800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1427241600000",
    "number": "1467429753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 23029",
            "city": "RICHFIELD",
            "state": "MN",
            "postal_code": "554230029",
            "telephone_number": "612-861-9123",
            "fax_number": "612-861-9155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "512 66TH AVE N",
            "city": "BROOKLYN CENTER",
            "state": "MN",
            "postal_code": "554301643",
            "telephone_number": "763-560-3334"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WITTENBERG",
        "first_name": "BRUCE",
        "middle_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-05",
        "last_updated": "2015-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MN",
            "license": "9625",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Trista Willis
• Ashly Wilson, OTR/L
• Celia JM Wilson
• Gabriella Grace Winter
• Liam Witte
• Melissa Wollman, LICSW
• Angela Wong, MS
• Colette Lucia Wood Sime, RN
• Tammy Lynn Wood-Behnke, M.A.
• Keri Woodford-Blue

• Dentist in Brooklyn Center, MN
• Providers in Brooklyn Center, MN by specialty
• Dentist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2015; 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.