Organization
KENNETH B WEDDELL PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH BRUCE WEDDELL DDS (OWNER)
(952) 884-7706
Entity
Organization
Contact information
Practice address
8900 PENN AVE S STE 211, BLOOMINGTON, MN 55431-2068
(952) 884-7706
(952) 881-6006
Mailing address
8900 PENN AVE S STE 211, BLOOMINGTON, MN 55431-2068
(952) 884-7706
(952) 881-6006
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D12619
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1104884147
NPI
—
Enumeration date
09/07/2012
Last updated
08/09/2023
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