Bruce Alan Anderson II, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2901015521 Issued in MI

Practice address

2864 Ashmun Street
Sault Tribal Health Center
Sault Ste Marie, MI 49783

Phone

(906) 632-5200

NPI assigned

Jul 31, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154304000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1013923010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2864 ASHMUN STREET",
            "city": "SAULT SAINTE MARIE",
            "state": "MI",
            "postal_code": "49783",
            "telephone_number": "906-632-5260",
            "fax_number": "906-632-5276"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2864 ASHMUN STREET",
            "address_2": "SAULT TRIBAL HEALTH CENTER",
            "city": "SAULT STE MARIE",
            "state": "MI",
            "postal_code": "49783",
            "telephone_number": "906-632-5200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "BRUCE",
        "middle_name": "ALAN",
        "name_suffix": "II",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-31",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "2901015521",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2849111",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Louis William Bergman
• Melanie A Cook, OPTICAN HEARING AID
• Ralph J Duman, MD
• Heather Patricia Fasulo, RPH
• Great Lakes Recovery Centers

• General Practice Dentistry in Sault Ste Marie, MI
• Providers in Sault Ste Marie, MI by specialty
• General Practice Dentistry in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.