Active NPI
Douglas James Andreasen, DMD
- Dentist
- Waco, TX
National Provider Identifier
1013400076
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 34064
- Practice address
- 1701 Lake Success Dr
Waco, TX 76710-2964 - Phone
- (254) 772-1827
- Fax
- (254) 772-9594
- NPI assigned
- Jun 13, 2018
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 34064 | TX | Primary |
Addresses
Primary practice location
1701 Lake Success Dr
Waco, TX 76710-2964
Mailing address
6429 Crystal CT
Waco, TX 76712-6969
Phone (630) 338-2450
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 34064 | TX | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dental Station Family Dentistry, P.a. | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Practice Dentistry
- Waco, TX
- NPI 1942392691
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1528848000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1528848000000",
"number": "1013400076",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6429 CRYSTAL CT",
"city": "WACO",
"state": "TX",
"postal_code": "767126969",
"telephone_number": "630-338-2450"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1701 LAKE SUCCESS DR",
"city": "WACO",
"state": "TX",
"postal_code": "767102964",
"telephone_number": "254-772-1827",
"fax_number": "254-772-9594"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANDREASEN",
"first_name": "DOUGLAS",
"middle_name": "JAMES",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-06-13",
"last_updated": "2018-06-13",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "TX",
"license": "34064",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waco, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.