Mary Colleen Anderson, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

016.0134179 Issued in VT

Practice address

61 Pine St
Bristol, VT 05443-1043

Phone

(802) 453-3911

NPI assigned

Apr 8, 2008

Last updated

Oct 16, 2023By 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)

Enrolled

State licenses

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

{
    "created_epoch": "1207612800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697414400000",
    "number": "1568635837",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 363",
            "city": "BETHEL",
            "state": "VT",
            "postal_code": "050320363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "61 PINE ST",
            "city": "BRISTOL",
            "state": "VT",
            "postal_code": "054431043",
            "telephone_number": "802-453-3911"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "79 South Windsor St",
            "address_purpose": "LOCATION",
            "city": "South Royalton",
            "state": "VT",
            "postal_code": "050689625",
            "country_code": "US",
            "telephone_number": "802-431-6060",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "MARY",
        "middle_name": "COLLEEN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-04-08",
        "last_updated": "2023-10-16",
        "certification_date": "2023-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MA",
            "license": "DN1855175",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "VT",
            "license": "016.0134179",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Bristol, VT
• Providers in Bristol, VT by specialty
• Dentist in Vermont

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2023; 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.