| Kenneth B Weddell Pllc | |
|
8900 Penn Ave S Ste 211 Bloomington MN 55431-2068 | |
| (952) 884-7706 | |
| (952) 881-6006 |
| Full Name | Kenneth B Weddell Pllc |
|---|---|
| Speciality | Dentist |
| Location | 8900 Penn Ave S Ste 211, Bloomington, Minnesota |
| Authorized Official Name and Position | Kenneth Bruce Weddell (OWNER) |
| Authorized Official Contact | 9528847706 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kenneth B Weddell Pllc 8900 Penn Ave S Ste 211 Bloomington MN 55431-2068 Ph: (952) 884-7706 | Kenneth B Weddell Pllc 8900 Penn Ave S Ste 211 Bloomington MN 55431-2068 Ph: (952) 884-7706 |
| NPI Number | 1073862819 |
|---|---|
| Provider Enumeration Date | 09/07/2012 |
| Last Update Date | 08/09/2023 |
| Medicare PECOS PAC ID | 6406084896 |
|---|---|
| Medicare Enrollment ID | O20140109001658 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073862819 | NPI | - | NPPES |
| 1104884147 | Other | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | D12619 (Minnesota) | Primary |
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