Mary L Anderson, DDS
Individual provider Active NPI General Practice Dentistry · Maplewood, MN
NPI 1831200674 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1831200674
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 9871 (MN)
- Practice address
- 2165 White Bear Ave
Maplewood, MN 55109 - Phone
- (651) 770-8828
- Fax
- (651) 779-1570
- NPI assigned
- Aug 31, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20061201000256 | MN | Practitioner - Oral Surgery | 4981602836 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Group Health, Inc. | General Practice | Current |
Accepting new patients |
| Group Health, Inc. | General Practice | Current |
Accepting new patients |
| Group Health, Inc. | Current | Accepting new patients |
Locations
8600 Nicollet Ave S
Minneapolis, MN 55420
Phone (952) 887-6600
2165 White Bear Ave N
Saint Paul, MN 55109
Phone (651) 523-9800
3930 Northwoods Dr
Saint Paul, MN 55112
Phone (651) 490-6775
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 9871 | MN | Yes |
Addresses
Primary practice location
2165 White Bear Ave
Maplewood, MN 55109
Mailing address
Mail Code 21113a
PO Box 1309
Minneapolis, MN 55440-1309
Phone (952) 883-5151
Other providers in Maplewood, MN
- Anchored Arms Healthcare Services LLC
- Dacotah Stephen Anderson
- Donald S Anderson
- Kari Malia Anderson
- Mary Anderson
- Mary Sullivan Anderson
- Nancy R Anderson
- Andrew J Will MD PA
- Zehra Ansari
- Ashley Ann Antolick
All providers in Maplewood, MN · General Practice Dentistry in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.