John Carlton Wittenstrom, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D10082 Issued in MN

Practice address

14990 Glazier Ave Ste 100
Apple Valley, MN 55124-7819

Phone

(612) 861-9123

Fax

(612) 861-9155

NPI assigned

Mar 14, 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

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.

• PDG, P.a.

  • General Practice Dentistry
  • Apple Valley, MN
  • NPI 1841366093
  NPD (past)

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

{
    "created_epoch": "1142294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681257600000",
    "number": "1659340503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14990 GLAZIER AVE STE 100",
            "city": "APPLE VALLEY",
            "state": "MN",
            "postal_code": "551247819",
            "telephone_number": "952-431-5114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14990 GLAZIER AVE STE 100",
            "city": "APPLE VALLEY",
            "state": "MN",
            "postal_code": "551247819",
            "telephone_number": "612-861-9123",
            "fax_number": "612-861-9155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WITTENSTROM",
        "first_name": "JOHN",
        "middle_name": "CARLTON",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-14",
        "last_updated": "2023-04-12",
        "certification_date": "2023-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D10082",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nana A Wilmot-Desouza, M.D
• Andree Wilson-Nixa
• Hilary Armstrong Winkelmann, FNP
• Paul Allen Winkelmann, DPT
• Lindsey Wise
• Jeanne L Wittrock, MD
• Ryan Michael Wohlman, PSY.D.
• Shannon Wohlman, MA, LMFT, LSW
• Andrea Rachelle Wojahn, PA-C
• Michael A Wolfe, D.D.S.

• General Practice Dentistry in Apple Valley, MN
• Providers in Apple Valley, 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 Apr 12, 2023; 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.