Paul Daniel Anderson, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

9267 Issued in MN

Practice address

4778 Banning Ave
White Bear Lake, MN 55110-3264

Phone

(651) 426-8998

NPI assigned

Dec 2, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

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.

• White Bear Smiles, P.a.

  • Dentist
  • White Bear Lake, MN
  • NPI 1396202917
  NPD (past) Authorized official

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

{
    "created_epoch": "1165017600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1659449098",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "399 LOCUST ST",
            "city": "MAHTOMEDI",
            "state": "MN",
            "postal_code": "55115",
            "telephone_number": "651-653-5283"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4778 BANNING AVE",
            "city": "WHITE BEAR LAKE",
            "state": "MN",
            "postal_code": "551103264",
            "telephone_number": "651-426-8998"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "PAUL",
        "middle_name": "DANIEL",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-02",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MN",
            "license": "9267",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicole Altstatt, CNP
• Amanda Vaske LLC
• Aurora Elizabeth Ames
• Amiot Spine Care, PLLC
• Kristina Lorraine Anderson
• Sarah Shore Anderson, PHARMD
• James S Anthony, PHD, LP
• Joel Thomas Anthony, D.C.
• Arcadia Counseling LLC
• Axis Minnesota, Inc.

• Dentist in White Bear Lake, MN
• Providers in White Bear Lake, MN by specialty
• Dentist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.