Elizabeth Ann Amundson, D.D.S.
Individual provider Active NPI Dentist · Alexandria, MN
NPI 1508094947 · NPPES record last updated Oct 3, 2013
Key facts
- NPI
- 1508094947
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- D12992 (MN)
- Practice address
- 2306 S. Broadway Street S
Suite 4
Alexandria, MN 56308-3461 - Phone
- (320) 762-5216
- Fax
- (320) 762-5694
- NPI assigned
- Jun 24, 2009
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150526001883 | MN | Order and Referring Only - Oral Surgery |
3577883917 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D12992 | MN | MD | Dentist |
| 6409-15 | WI | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dentistry at the Center | General Practice | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | D12992 | MN | Yes |
| General Practice Dentistry | 1223G0001X | 6409-15 | WI |
Addresses
Primary practice location
2306 S. Broadway Street S
Suite 4
Alexandria, MN 56308-3461
Mailing address
2306 S. Broadway Street S
Suite 4
Alexandria, MN 56308-3461
Phone (320) 762-5216
Other providers in Alexandria, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 3, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.