Anderson Family Dental PA

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

12543 Issued in MN

Legal business name

ANDERSON FAMILY DENTAL PA

Practice address

209 McLean Ave
Coleraine, MN 55722-0756

Phone

(218) 245-1278

Fax

(218) 245-1333

NPI assigned

Aug 1, 2012

Organization subpart

No

Name

Jordan David Anderson, DDSNPI 1851550040

Title

Owner

Phone

(218) 245-1278

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jordan D Anderson, D.D.S.

  • General Practice Dentistry
  • Coleraine, MN
  • NPI 1851550040

  General Practice

  NPD (past) Authorized official
• Richard James Thouin, DDS

  • Dentist
  • Coleraine, MN
  • NPI 1740260405
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Aug 1, 2012.

{
    "created_epoch": "1343779200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1343779200000",
    "number": "1356697973",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 756",
            "city": "COLERAINE",
            "state": "MN",
            "postal_code": "557220756",
            "telephone_number": "218-245-1278",
            "fax_number": "218-245-1333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "209 MCLEAN AVE",
            "city": "COLERAINE",
            "state": "MN",
            "postal_code": "557220756",
            "telephone_number": "218-245-1278",
            "fax_number": "218-245-1333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANDERSON FAMILY DENTAL PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-01",
        "last_updated": "2012-08-01",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "JORDAN",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "218-245-1278",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "12543",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jordan D Anderson, D.D.S.
• Michael Velemir Baich, MD
• Cedar Ridge Dental Centre
• Dr VM Baich PA
• Zachary Nathaniel Gordon

• All providers in Coleraine, MN
• General Practice Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.