Richard Brian Wittenberg, D.D.S.

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

8787 Issued in MN

Practice address

13055 Riverdale Dr NW
Suite 400
Coon Rapids, MN 55448-8403

Phone

(612) 243-9357

Fax

(763) 323-7487

NPI assigned

Aug 19, 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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1155945600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1760596308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3880 ZIRCON LN N",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554462837",
            "telephone_number": "763-478-8554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13055 RIVERDALE DR NW",
            "address_2": "SUITE 400",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554488403",
            "telephone_number": "612-243-9357",
            "fax_number": "763-323-7487"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WITTENBERG",
        "first_name": "RICHARD",
        "middle_name": "BRIAN",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "MN",
            "license": "8787",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Valencia Yvonne Williams
• Allison Damon Willkom, DPM
• Angela Wilson
• Robert D Winston, M.D.
• Joseph John Wittenberg, LICSW
• Suzanne T Witterholt, MD
• Alyssa Rose Wojciechowski, MD
• Christina Marie Wolf, DPT
• Julie Ann Wolfgram, NP-C
• Shawn E Wolk, CRNA

• Periodontics in Coon Rapids, MN
• Providers in Coon Rapids, MN by specialty
• Periodontics in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.