KENNETH B WEDDELL PLLC
NPI 1073862819
Dentist - General Practice in Bloomington, MN

Q: What is Kenneth B Weddell PLLC's NPI number?

The NPI number for Kenneth B Weddell PLLC is 1073862819. It was assigned to this organization in the NPPES registry on September 7, 2012.

Q: What is Kenneth B Weddell PLLC's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

Active since September 07, 2012

8900 PENN AVE S STE 211, BLOOMINGTON, MN 55431(952) 884-7706(952) 881-6006 Get Directions Write a Review

NPPES record last updated: August 9, 2023. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Aug 9, 2023, Aug 23, 2019 (2 updates tracked since 2019).

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About Kenneth B Weddell Pllc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KENNETH B WEDDELL PLLC (NPI 1073862819) is a healthcare organization registered as a general practice in Bloomington, Minnesota and active in the NPI registry since September 2012. The organization lists Kenneth Bruce Weddell, Owner, as its authorized official.

NPPES Registry Identity

NPI1073862819

Entity TypeOrganization

Primary Taxonomy1223G0001X

Legal Business NameKENNETH B WEDDELL PLLC

Location Address8900 PENN AVE S STE 211Bloomington, MN 55431-2068

Mailing Address8900 Penn Ave S Ste 211Bloomington, MN 55431-2068 · (952) 884-7706 · Fax (952) 881-6006

Phone(952) 884-7706

Fax(952) 881-6006

Organization SubpartNo

Authorized OfficialKenneth Bruce WeddellOwner · (952) 884-7706

Enumeration DateSeptember 7, 2012

Last NPPES UpdateAugust 9, 20232 updates tracked since enumeration

NPPES CertifiedAugust 9, 2023

✔ NPI 1073862819 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · General PracticeDental Providers

Taxonomy Code1223G0001X

License✔ Licensed in MN · D12619

Definition

A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

8900 PENN AVE S STE 211, Bloomington, MN 55431

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Other Identifiers 1

Other1104884147Npi

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include UnitedHealthcare.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Kenneth B Weddell Pllc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Kenneth B Weddell PLLC, which bills Medicare for the services this clinician delivers.

Clinician (1)

Kenneth Weddell, DDS

Dentist

NPI 1104884147

111 W DAYTON ST
Fremont, MI 49412

(231) 924-3600

✔ PECOS378 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kenneth B Weddell PLLC's NPI number?

The NPI number for Kenneth B Weddell PLLC is 1073862819. It was assigned to this organization in the NPPES registry on September 7, 2012.

Where is Kenneth B Weddell PLLC located?

Kenneth B Weddell PLLC is located at 8900 Penn Ave S Ste 211, Bloomington, MN 55431. The listed phone number is (952) 884-7706.

What is Kenneth B Weddell PLLC's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

Is Kenneth B Weddell PLLC enrolled in Medicare?

Yes. Kenneth B Weddell PLLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Kenneth B Weddell PLLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Dentist) reassigns their Medicare billing to Kenneth B Weddell PLLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

What insurance does Kenneth B Weddell PLLC accept?

Health plans from UnitedHealthcare list Kenneth B Weddell PLLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Kenneth B Weddell PLLC was last updated on August 9, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.