Keith Wolfenden, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

DEN.00203846 Issued in CO

Practice address

430 Bimson Ave
Berthoud, CO 80513-1395

Phone

(970) 532-4209

NPI assigned

Jul 28, 2010

Sex

Male

Sole proprietor

Yes

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 FL

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.

• Wolfenden Family Dental, PLLC

  dba Berthoud Dental Care

  • Dental Clinic/Center
  • Berthoud, CO
  • NPI 1508448846
  NPD Authorized official
• Douglas Dentistry P a

  • Durable Medical Equipment & Medical Supplies
  • Trinity, FL
  • NPI 1801358395
  NPD (past)
• Robert P. Wolfenden DDS, PA

  • Dentist
  • Trinity, FL
  • NPI 1487921193
  NPD (past)

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

{
    "created_epoch": "1280275200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1669075200000",
    "number": "1629382981",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "329 BRONCO CT",
            "city": "BERTHOUD",
            "state": "CO",
            "postal_code": "805132829",
            "telephone_number": "904-703-2782"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "430 BIMSON AVE",
            "city": "BERTHOUD",
            "state": "CO",
            "postal_code": "805131395",
            "telephone_number": "970-532-4209"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOLFENDEN",
        "first_name": "KEITH",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-07-28",
        "last_updated": "2022-11-22",
        "certification_date": "2022-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CO",
            "license": "DEN.00203846",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Miranda Hope Wichelns, LCSW
• Sheree Wilkinson, SLP
• Brett Wisniewski, D.C.
• WM. Rex Eland, O.D., P.C.
• Wolfenden Family Dental, PLLC (Berthoud Dental Care)
• Dawn Cecil Wood, APRN
• Yellow Butterfly Counseling, LLC
• Jake Thomas Yuska

• Dentist in Berthoud, CO
• Providers in Berthoud, CO by specialty
• Dentist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2022; 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.