Katherine Anne Nordeen, D.D.S.

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

D12843 Issued in MN

Practice address

15160 Foliage Ave Ste 110
Apple Valley, MN 55124-5903

Phone

(952) 715-6177

NPI assigned

Jun 23, 2010

Last updated

Mar 17, 2025By 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

Other names 1

• Katherine Anne Wild Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Carousel Pediatric Dentistry PLLC

  • Pediatric Dentistry
  • Apple Valley, MN
  • NPI 1114514205
  NPD
• Vcu School of Dentistry

  • Pediatric Dentistry
  • Richmond, VA
  • NPI 1760682215
  NPD (past)

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

{
    "created_epoch": "1277251200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742169600000",
    "number": "1558672733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15160 FOLIAGE AVE STE 110",
            "city": "APPLE VALLEY",
            "state": "MN",
            "postal_code": "551245903",
            "telephone_number": "527-156-1779"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15160 FOLIAGE AVE STE 110",
            "city": "APPLE VALLEY",
            "state": "MN",
            "postal_code": "551245903",
            "telephone_number": "952-715-6177"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NORDEEN",
        "first_name": "KATHERINE",
        "middle_name": "ANNE",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-06-23",
        "last_updated": "2025-03-17",
        "certification_date": "2025-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "MN",
            "license": "D12843",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "MN",
            "license": "D12843",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KATHERINE",
            "last_name": "WILD",
            "middle_name": "ANNE",
            "credential": "D.D.S.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Nobelcaretransport LLC
• Melissa A Nokes, MA, LMFT
• Bosteya Hassan Noor
• Tara Marie Nordberg, FNP
• Deborrah Jane Nordblom, D.D.S.
• Kyle Nordeen, DDS
• Shanna Lee Nordeen, PHARM D
• Jenny Marie Nordell, MA, LPCC
• Tad Michel Norris, D.C.
• North Star Balance LLC

• Pediatric Dentistry in Apple Valley, MN
• Providers in Apple Valley, MN by specialty
• Pediatric Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2025; 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.