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Active NPI 1174011597 Individual Practitioner Male Practitioner

Dr. Jordan Dittberner , DDS

Dentist - General Practice • White Bear Lake, MN

Professional Overview & Biography Verified Profile Summary

Dr. Jordan Dittberner, DDS is a registered healthcare professional specializing in Dentist - General Practice in White Bear Lake, MN. Practice services are available at 4700 WHITE BEAR PKWY under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

4700 White Bear Pkwy

White Bear Lake, MN 551103336

Telephone 6517627677
Associated Practice Facility / Clinic
🏢 Isaacson Gentle Dentistry Facility NPI 1801037437

Specialty Benchmarks & Practice Insights

Comparative analytics for Dentist - General Practice in White Bear Lake, MN

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

Practicing in White Bear Lake, 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 WI 1001789

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.

Secondary Practice Locations

108 Chieftain St.

Osceola, WI 54020

Phone: 7152942202

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

5 Associated Practitioners
Dr. Jonathan Siverson , DDS

Dentist - General Practice

NPI 1205030491

Doctor of Dental Surgery

NPI 1396840559

Doctor of Dental Surgery

Dr. Daniel Isaacson , DDS

Dentist - General Practice

NPI 1598822637

Doctor of Dental Surgery

Dr. Michael Weisbrod , DDS

Dentist - General Practice

NPI 1659571107

Doctor of Dental Surgery

NPI 1851183990

Doctor of Dental Surgery

Career & Practice History Timeline

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

6 Historical Events
NPI Profile Active May 01, 2018

NPI status registered as active in NPPES database

📍
Updated Practice Location May 01, 2018

Registered at 4700 WHITE BEAR PKWY, WHITE BEAR LAKE, MN 551103336 (Tel: 6517627677)

📍
Updated Business Mailing Address May 01, 2018

Registered at 7504 115TH ST N, WHITE BEAR LAKE, MN 551106182 (Tel: 6513081177)

👤
Provider Name / Credentials Updated May 01, 2018

Recorded as JORDAN DITTBERNER, DDS

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) May 01, 2018

Dentist (License #1001789 in WI)

🟢
Initial NPI Registration & Enumeration May 01, 2018

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: 1174011597
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: May 01, 2018
Last Update: May 01, 2018
Sole Proprietor: Yes

Mailing Address

7504 115th St N

White Bear Lake, MN 551106182

Phone: 6513081177

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.