Ammon L Anderson, D.D.S.

Primary specialty

EndodonticsTaxonomy code 1223E0200X

License

08617 Issued in IA

Practice address

2910 Hamilton Blvd
Suite 101
Sioux City, IA 51104-2423

Phone

(712) 255-8017

NPI assigned

May 29, 2009

Sex

Male

Sole proprietor

Yes

Medicare fee-for-service enrollment

Enrolled in IA

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

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on May 29, 2009.

{
    "created_epoch": "1243555200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1243555200000",
    "number": "1760618110",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2910 HAMILTON BLVD",
            "address_2": "SUITE 101",
            "city": "SIOUX CITY",
            "state": "IA",
            "postal_code": "511042423",
            "telephone_number": "712-255-8017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2910 HAMILTON BLVD",
            "address_2": "SUITE 101",
            "city": "SIOUX CITY",
            "state": "IA",
            "postal_code": "511042423",
            "telephone_number": "712-255-8017"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "AMMON",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-05-29",
        "last_updated": "2009-05-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NE",
            "license": "6543",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WY",
            "license": "1127",
            "primary": false
        },
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "IA",
            "license": "08617",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amera SL of Sioux City, LLC
• American Home Health Care Company
• American Homepatient, Inc.
• American Prosthetics & Orthotics, Inc.
• Richard C Andersen, DO
• Ashley Jean Anderson, PMHNP-BC
• August Anderson, MD
• Courtney Anderson
• Crystal Anderson
• Emily Ranae Anderson, CRNA

• All providers in Sioux City, IA
• Endodontics in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2009; 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.