Thor Jason Anderson, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

4619-015 Issued in WI

Practice address

1520 Vernon St
Stoughton, WI 53589-2260

Phone

(608) 873-7277

NPI assigned

Sep 28, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

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 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

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

{
    "created_epoch": "1159401600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1790877629",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1520 VERNON ST",
            "city": "STOUGHTON",
            "state": "WI",
            "postal_code": "535892260"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1520 VERNON ST",
            "city": "STOUGHTON",
            "state": "WI",
            "postal_code": "535892260",
            "telephone_number": "608-873-7277"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "THOR",
        "middle_name": "JASON",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-28",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "4619-015",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Guirish A Agni, MD
• Richard A Albright, D.D.S.
• Mary Allen, LCSW
• Paul R Allen, RN, RCS
• Thane B Anderson, D.D.S.
• Aryv of Arkansas LLC
• Aryv of Idaho LLC
• Aryv of Indiana LLC
• Aryv of Oklahoma LLC
• Aryv of Pennsylvania LLC

• General Practice Dentistry in Stoughton, WI
• Providers in Stoughton, WI by specialty
• General Practice Dentistry in Wisconsin

• 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.