Erika Marie Theisen, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D12795 Issued in MN

Practice address

22 2ND Ave S
Sauk Rapids, MN 56379-1408

Phone

(320) 252-7806

Fax

(320) 252-9044

NPI assigned

Jun 2, 2010

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Dr. Erika Marie Wetzel Former name

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1275436800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1458086400000",
    "number": "1083934905",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22 2ND AVE S",
            "city": "SAUK RAPIDS",
            "state": "MN",
            "postal_code": "563791408",
            "telephone_number": "320-252-7806",
            "fax_number": "320-252-9044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22 2ND AVE S",
            "city": "SAUK RAPIDS",
            "state": "MN",
            "postal_code": "563791408",
            "telephone_number": "320-252-7806",
            "fax_number": "320-252-9044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THEISEN",
        "first_name": "ERIKA",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-06-02",
        "last_updated": "2016-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D12795",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ERIKA",
            "last_name": "WETZEL",
            "middle_name": "MARIE",
            "prefix": "DR.",
            "credential": "DDS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kaylee Alexis Sylla, LMFT
• Kathleen Mary Szczech
• Luke Szczech
• Ranadene Kay Tapio, CMRS
• Tending Relationships, LLC
• Thomas N Johnson Optometric Corp
• Charles L Thompson, D.C.
• Dawn Thompson
• Tim Tinius PHD PA
• Brea Kay Timlin

• General Practice Dentistry in Sauk Rapids, MN
• Providers in Sauk Rapids, MN by specialty
• General Practice Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2016; 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.