# KENNETH B WEDDELL DDS PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Fremont Dental Associates PC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1730161175
- **Authorized official:** DR. KENNETH B WEDDELL DDS (REPRESENTATIVE)
- **Authorized official phone:** (231) 924-3600

## Contact information

- **Practice address:** 111 W DAYTON ST, FREMONT, MI 49412-1112
- **Practice address phone:** (231) 924-3600
- **Practice address fax:** (231) 924-9720
- **Mailing address:** PO BOX 437, 111 W DAYTON ST, FREMONT, MI 49412-0437
- **Mailing address phone:** (231) 924-3600
- **Mailing address fax:** (231) 924-9720

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | NULL | Yes |
| 122300000X | Dentist | — | — | Yes |

## Other

- **Enumeration date:** 11/18/2005
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 847376 | UN CONCORDIA | — |
| 01 | — | D808140 | BCBS | MI |