Active NPI
Teara Jervon Wuollet, DDS
- Dentist
- West St Paul, MN
National Provider Identifier
1891473575
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- D15000
- Practice address
- 1963 Robert St S # 100
West St Paul, MN 55118-3942 - Phone
- (952) 237-2928
- NPI assigned
- Jul 11, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | D15000 | MN | Primary |
Addresses
Primary practice location
1963 Robert St S # 100
West St Paul, MN 55118-3942
Mailing address
14395 Hayes Rd
Apple Valley, MN 55124-6739
Phone (952) 237-2928
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D15000 | MN | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1689033600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1692230400000",
"number": "1891473575",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14395 HAYES RD",
"city": "APPLE VALLEY",
"state": "MN",
"postal_code": "551246739",
"telephone_number": "952-237-2928"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1963 ROBERT ST S # 100",
"city": "WEST ST PAUL",
"state": "MN",
"postal_code": "551183942",
"telephone_number": "952-237-2928"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WUOLLET",
"first_name": "TEARA",
"middle_name": "JERVON",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-07-11",
"last_updated": "2023-08-17",
"certification_date": "2023-08-17",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MN",
"license": "D15000",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in West St Paul, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.