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Deactivated NPI 1205005972 Deactivated / Inactive NPI Male Practitioner

Dr. Kenneth James Weidman , DDS

Dentist - General Practice • Breckenridge, MN

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Dr. Kenneth Weidman has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date February 26, 2008
NPI Deactivation Date June 27, 2018
Total Practice Duration ~10 Years of Practice (2008 – 2018)

Professional Overview & Biography Verified Profile Summary

Dr. Kenneth Weidman, DDS was a registered Dentist - General Practice practicing in Breckenridge, MN. Throughout an active medical career spanning 10 years, Dr. Weidman provided care at the practice location at 133 5TH ST N until profile deactivation on 2018-06-27.

Practice Location & Contact Primary Location

Practice Address

133 5th St N

Breckenridge, MN 565201420

Telephone 2186433865
Fax 2186431458

Specialty Benchmarks & Practice Insights

Comparative analytics for Dentist - General Practice in Breckenridge, MN

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 33.3 Yrs
Regional Practice Density
3 Specialists

Practicing in Breckenridge, MN (2262 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Dentist - General Practice Primary Specialty

NUCC Taxonomy Code: 1223G0001X

State License MN D7138

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.

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

7 Historical Events
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NPI Profile Deactivated June 27, 2018

Record deactivated on June 27, 2018

NPI Profile Active February 26, 2008

NPI status registered as active in NPPES database

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Updated Practice Location February 26, 2008

Registered at 133 5TH ST N, BRECKENRIDGE, MN 565201420 (Tel: 2186433865)

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Updated Business Mailing Address February 26, 2008

Registered at 133 5TH ST N, BRECKENRIDGE, MN 565201420 (Tel: 2186433865)

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Provider Name / Credentials Updated February 26, 2008

Recorded as KENNETH WEIDMAN, D.D.S.

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Medical Taxonomy / Specialty Registered (Primary Specialty) February 26, 2008

Dentist (License #D7138 in MN)

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Initial NPI Registration & Enumeration February 26, 2008

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1205005972
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: February 26, 2008
Last Update: February 26, 2008
Deactivation Date: June 27, 2018

Mailing Address

133 5th St N

Breckenridge, MN 565201420

Phone: 2186433865

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.