Jessica Lee Vanhavermaet, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

D14416 Issued in MN

Practice address

122 Colfax Ave SW
Wadena, MN 56482-1470

Phone

(218) 631-4525

NPI assigned

Jul 15, 2020

Last updated

Dec 22, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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.

• Wadena Family Dental, P. a.

  • General Practice Dentistry
  • Wadena, MN
  • NPI 1881864049
  NPD (past)

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

{
    "created_epoch": "1594771200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640131200000",
    "number": "1356959423",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "122 COLFAX AVE SW",
            "city": "WADENA",
            "state": "MN",
            "postal_code": "564821470",
            "telephone_number": "701-318-3433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "122 COLFAX AVE SW",
            "city": "WADENA",
            "state": "MN",
            "postal_code": "564821470",
            "telephone_number": "218-631-4525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANHAVERMAET",
        "first_name": "JESSICA",
        "middle_name": "LEE",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-07-15",
        "last_updated": "2021-12-22",
        "certification_date": "2021-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MN",
            "license": "D14416",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D14416",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Donald D Twaddle
• Katie Lynn Tyrrell, LPCC
• Jamie L Udy, FNP
• Thomas P. Van Bruggen, M.D.
• Danelle Mary Vandermay
• Wadena County Social Services
• Wadena Eye Clinic LTD
• Wadena Family Dental, P. a.
• Wadena Medical Center, LTD
• Wadena-Deer Creek Public School

• Dentist in Wadena, MN
• Providers in Wadena, MN by specialty
• Dentist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2021; 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.