Devren Clay Anderson, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D0918 Issued in SD

Practice address

6104 S Lyncrest Ave
Sioux Falls, SD 57108-2560

Phone

(605) 274-6191

Fax

(605) 274-6192

NPI assigned

Dec 18, 2006

Last updated

Aug 30, 2010By 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 SD

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

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Dental Wellness, Devren Anderson, DDS, PC

  • General Practice Dentistry
  • Sioux Falls, SD
  • NPI 1629685243
  NPD (past)

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

{
    "created_epoch": "1166400000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1283126400000",
    "number": "1063575629",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6104 S LYNCREST AVE",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571082560",
            "telephone_number": "605-274-6191",
            "fax_number": "605-274-6192"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6104 S LYNCREST AVE",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571082560",
            "telephone_number": "605-274-6191",
            "fax_number": "605-274-6192"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "DEVREN",
        "middle_name": "CLAY",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-18",
        "last_updated": "2010-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "SD",
            "license": "D0918",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "490632200",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amy Michelle Anderson, PA-C
• Angela Jean Anderson
• Anna Anderson, CRNA
• Anna Marie Anderson, NP
• Carrie Jane Anderson, APRN, CRNA
• Douglas L Anderson, PSYD
• Drew Allen Anderson, BSN-RN
• Erik Anderson, MSW, LCSW
• Eva Marie Anderson, O.D.
• Gabrielle Kathryn Anderson, OD

• General Practice Dentistry in Sioux Falls, SD
• Providers in Sioux Falls, SD by specialty
• General Practice Dentistry in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2010; 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.