DR. WALLACE JAY ANDERSON (NPI# 1518041797) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1518041797 |
| Entity Type | Individual |
| Full Name | DR. WALLACE JAY ANDERSON |
| Credential | DDS |
| Practice Address |
1260 County Road E West Arden Hills MN 55112-3737 |
| Mailing Address |
8833 80th Street N Stillwater MN 55082 |
| Practice Telephone | 6516390452 |
| Mailing Telephone | 6516536558 |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 122300000X | Dentist | 7786 | MN | Dental Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467080762 | Wallace Roy Anderson IIi | Student in an Organized Health Care Education/Training Program | 701 Grove Rd, Greenville, SC 29605-4210 | 2020-03-31 |
| 1881622314 | Wallace Steve Anderson | Family Medicine | 1311 Ocilla Rd, Douglas, GA 31533-2213 | 2006-06-30 |
| 1578510913 | Wallace M Anderson | Radiology | 4500 Memorial Dr, Dept Radiology, Belleville, IL 62226-5360 | 2006-05-30 |
| Street Address |
1260 COUNTY ROAD E WEST |
| City | ARDEN HILLS |
| State | MN |
| Zip Code | 55112-3737 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932729704 | Owegio Wreh | Technician | 1405 Silver Lake Road Suite 15, New Brighton, MN 55112 | 2020-04-22 |
| 1205497435 | Silver Lake Smiles Family Dentistry | Clinic/Center | 2370 Palmer Drive, New Brighton, MN 55112 | 2019-06-27 |
| 1932766169 | Matthew Thomas Hanowski | Dentist | 2442 Mounds View Boulevard, Mounds View, MN 55112 | 2019-05-22 |
| 1437619988 | Marjean Diane Leary | Registered Nurse | 338 New Brighton Road, Apt, Suite, Bldg. (optional), New Brighton, MN 55112 | 2019-03-21 |
| 1558802728 | Krishna Katira | Student in an Organized Health Care Education/Training Program | 2442 County Hwy 10, Mounds View, MN 55112 | 2017-03-20 |
| 1245781608 | Evan Fredrick Lieberman | Counselor | 1900 Silver Lake Rd, Suite 110, New Brighton, MN 55112 | 2016-10-20 |
| 1093262065 | Ryan Zinken | Nurse Practitioner | 1900 Silver Lake Road, Suite 110, New Brighton, MN 55112 | 2016-09-07 |
| 1447703228 | Alison Glodek | Social Worker | 2543 17th St Nw, New Brighton, MN 55112 | 2016-07-28 |
| 1659728194 | Ge Vang Sr. | Driver | 2160 County Road E West #205, 2160 County Road E West #205, New Brighton, MN 55112 | 2016-05-14 |
| 1114373578 | Jessica Gapinski | Specialist/Technologist | 3900 Bethel Drive, Arden Hills, MN 55112 | 2016-05-04 |
| Find all providers in zip 55112 | ||||
| Taxonomy Code | 122300000X |
| Grouping | Dental Providers |
| Classification | Dentist |
| A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780020966 | Fouad Badr | Dentist | 3130 Cleveland Ave N, Arden Hills, MN 55112 | 2013-05-15 |
| 1730679325 | Nadine Yacoub | Dentist | 3930 Northwoods Dr, Arden Hills, MN 55112 | 2018-05-18 |
| 1437417227 | Sunnie F Adsitt | Dentist | 3930 Northwoods Dr, Healthpartners Arden Hills, Arden Hills, MN 55112-6963 | 2012-04-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730788498 | Modern Dental Professionals | Dentist | 676 County Road 10 Ne, Blaine, MN 55434-2329 | 2020-10-22 |
| 1588261812 | New London Family Dental | Dentist | 15 Ash St Se, New London, MN 56273 | 2020-10-09 |
| 1164036422 | Lolita Hicks | Dentist | 1290 Salem Rd Sw Ste 10, Rochester, MN 55902-4210 | 2020-09-03 |
| 1326650961 | Mcgann Family Dental | Dentist | 8981 33rd St N, Lake Elmo, MN 55042-9209 | 2020-08-17 |
| 1154931988 | Jordan Jeffrey Bolger | Dentist | 13899 Highway 15 S Frontage Rd, Savage, MN 55378-5537 | 2020-08-06 |
| 1285243733 | Grant R. Sorensen, Dds | Dentist | 1029 3rd Ave Ste 1, Worthington, MN 56187-2399 | 2020-07-29 |
| 1851909436 | Matthew Rohlf | Dentist | 5378 E Viking Blvd, Wyoming, MN 55092 | 2020-07-20 |
| 1205444106 | Sidra Zahooruddin | Dentist | 107 Dupont Ave, Nw, Renville, MN 56284 | 2020-07-16 |
| 1104434380 | Jongseuk Lim | Dentist | 1119 W Frontage Rd, Owatonna, MN 55060-5663 | 2020-07-14 |
| 1699393942 | Danika Elizabeth Jackson | Dentist | 237 Radio Dr Ste 110, Woodbury, MN 55125-4478 | 2020-07-13 |
| Find all providers with the same taxonomy | ||||
| City | ARDEN HILLS |
| Zip Code | 55112 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.