Organization
KENNETH B WEDDELL DDS PC
Active
Other names
Fremont Dental Associates PC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH B WEDDELL DDS (REPRESENTATIVE)
(231) 924-3600
Entity
Organization
Contact information
Practice address
111 W DAYTON ST, FREMONT, MI 49412-1112
(231) 924-3600
(231) 924-9720
Mailing address
PO BOX 437, 111 W DAYTON ST, FREMONT, MI 49412-0437
(231) 924-3600
(231) 924-9720
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
847376
UN CONCORDIA
—
01
—
D808140
BCBS
MI
Enumeration date
11/18/2005
Last updated
08/22/2020
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