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General NPI Number Information
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NPI Number | 1730161175
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Entity Type | Organization
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Legal Business Name | KENNETH B WEDDELL DDS PC
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Dates
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Enumeration Date | 11/18/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 111 W DAYTON ST
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City | FREMONT
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State | MI
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Zip | 49412-1112
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Country | US
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Telephone | 231-924-3600
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Fax | 231-924-9720
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Provider Business Mailing Address
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Address Line | PO BOX 437 111 W DAYTON ST
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City | FREMONT
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State | MI
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Zip | 49412-0437
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Country | US
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Telephone | 231-924-3600
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Fax | 231-924-9720
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Authorized Official
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Title or Position | REPRESENTATIVE
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Name | DR. KENNETH B WEDDELL
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Credential | DDS
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Telephone | 231-924-3600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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