Jennifer L Anderson, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019028537 Issued in IL

Practice address

208 N. Walnut Ave
Forreston, IL 61030

Phone

(815) 938-2575

Fax

(815) 938-2363

NPI assigned

Jun 12, 2009

Last updated

Jan 3, 2013By 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

• Jennifer L Anderson Other name

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

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

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.

• Autumn Dental of Mokena LLC

  • Dental Clinic/Center
  • Mokena, IL
  • NPI 1427576750
  NPD (past)
• Shady Oak Dental LLC Oral and Maxillofacial Surgeons of Northwest Il

  • Oral and Maxillofacial Surgery Clinic/Center
  • Forreston, IL
  • NPI 1437703113
  NPD (past)

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

{
    "created_epoch": "1244764800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1357171200000",
    "number": "1699902080",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 368",
            "address_2": "208 N. WALNUT AVE",
            "city": "FORRESTON",
            "state": "IL",
            "postal_code": "61030",
            "telephone_number": "815-938-2575",
            "fax_number": "815-938-2363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "208 N. WALNUT AVE",
            "city": "FORRESTON",
            "state": "IL",
            "postal_code": "61030",
            "telephone_number": "815-938-2575",
            "fax_number": "815-938-2363"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "JENNIFER",
        "middle_name": "L",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-06-12",
        "last_updated": "2013-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019028537",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "6410",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "ANDERSON",
            "middle_name": "L",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Estella Allen
• Muhanned Assaf
• Paige Marie Chamberlin, MSW
• Forreston Dental
• Forreston Fire Protection District
• Forrestville Valley U S D 221

• General Practice Dentistry in Forreston, IL
• Providers in Forreston, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2013; 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.