Active NPI
Macy Ruth Anderson, D.D.S
- General Practice Dentistry
- Glendale, WI
National Provider Identifier
1124641303
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 1002304
- Practice address
- 5150 N Port Washington Rd Ste 201
Glendale, WI 53217-5400 - Phone
- (414) 964-8850
- NPI assigned
- May 22, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| General Practice Dentistry | 1223G0001X | 1002304 | WI | Primary |
Addresses
Primary practice location
5150 N Port Washington Rd Ste 201
Glendale, WI 53217-5400
Mailing address
5150 N Port Washington Rd Ste 201
Glendale, WI 53217-5400
Phone (414) 964-8850
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 |
|---|---|---|---|
| 1002304 | WI | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1590105600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1660608000000",
"number": "1124641303",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5150 N PORT WASHINGTON RD STE 201",
"city": "GLENDALE",
"state": "WI",
"postal_code": "532175400",
"telephone_number": "414-964-8850"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5150 N PORT WASHINGTON RD STE 201",
"city": "GLENDALE",
"state": "WI",
"postal_code": "532175400",
"telephone_number": "414-964-8850"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANDERSON",
"first_name": "MACY",
"middle_name": "RUTH",
"name_prefix": "Dr.",
"credential": "D.D.S",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-05-22",
"last_updated": "2022-08-16",
"certification_date": "2022-08-16",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "WI",
"license": "1002304",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Glendale, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.