AVERA MARSHALL (NPI# 1962859058) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1962859058 |
| Entity Type | Organization |
| Organization Name | AVERA MARSHALL |
| Other Organization Name | AVERA MEDICAL GROUP DENTAL CARE |
| Practice Address |
197 N Tyler St Tyler MN 56178-1160 |
| Practice Telephone | 5072475591 |
| Mailing Telephone | 5072475591 |
| Enumeration Date | 2016-05-18 |
| Last Update Date | 2016-05-18 |
| Authorized Official Name | SHARON WILLIAMS (VP OF FINANCE & INFORMATION SERVICE) |
| Authorized Official Telephone | 5075379150 |
| Is Organization Subpart | Y |
| Parent Organization Name | AVERA MARSHALL |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 122300000X | Dentist | MN | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NOT ASSIGNED YET | NOT ASSIGNED YET | 01 |
| Other Name | Type Code |
|---|---|
| Avera Medical Group Dental Care | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396229746 | Avera Marshall | Clinic/Center | 1521 Carlson St Ste 200, Marshall, MN 56258-2626 | 2018-09-21 |
| 1154856839 | Avera Marshall | Clinic/Center | 300 S Bruce St Ste D, Marshall, MN 56258-1934 | 2017-05-01 |
| 1508177890 | Avera Marshall | Ophthalmology | 1040 3rd Ave, Mountain Lake, MN 56159-1587 | 2010-07-01 |
| 1346297041 | Avera Marshall | Home Health | 1104 E College Dr, Marshall, MN 56258-4270 | 2006-05-28 |
| 1659838290 | Avera Marshall | Occupational Therapist | 1420 E College Dr Ste 704, Marshall, MN 56258-2065 | 2019-03-01 |
| 1407330301 | Avera Marshall | Clinic/Center | 1521 Carlson St, Marshall, MN 56258-2626 | 2018-09-18 |
| 1437551785 | Avera Marshall | Clinic/Center | 300 S Bruce St, Marshall, MN 56258-1934 | 2014-09-18 |
| 1649688623 | Avera Marshall | Clinic/Center | 300 S Bruce St, Marshall, MN 56258-1934 | 2014-07-23 |
| 1710303227 | Avera Marshall | Clinic/Center | 300 S Bruce St, Marshall, MN 56258-1934 | 2014-03-07 |
| 1033535547 | Avera Marshall | In Home Supportive Care | 1104 E College Dr, Marshall, MN 56258-4270 | 2014-03-07 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | AVERA MARSHALL REGIONAL MEDICAL CENTER | 300 S Bruce St, Marshall, MN 56258-1934 |
| Street Address |
197 N TYLER ST |
| City | TYLER |
| State | MN |
| Zip Code | 56178-1160 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982194098 | Kristal Sue Wilmes | Dentist | 197 N Tyler St, Tyler, MN 56178-1160 | 2018-05-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689180259 | Align Family Chiropractic LLC | Chiropractor | 117 W Hughes Street, Tyler, MN 56178 | 2017-12-19 |
| 1639235971 | John Rice Utoft | Dentist | 197 North Tyler St, Tyler, MN 56178 | 2006-12-29 |
| 1154415172 | April Rose Hanson | Pharmacist | 240 Willow Street, Tyler, MN 56178 | 2006-10-03 |
| 1285676874 | Koster Pharmacy | Pharmacy | 183 N Tyler St, Tyler, MN 56178 | 2006-06-11 |
| 1104178946 | Candice Lou Vanderplaats | Nurse Practitioner | 240 Willow Street, Tyler, MN 56178 | 2012-10-03 |
| 1184832891 | Tyler Healthcare Center Dba Tyler Healthcare Pharmacy | General Acute Care Hospital | 240 Willow St., Tyler, MN 56178 | 2007-05-18 |
| 1326102237 | Avera Tyler | Medicare Defined Swing Bed Unit | 240 Willow Street, Tyler, MN 56178 | 2006-12-22 |
| 1225081474 | Robert William Tatreau | Family Medicine | 240 Willow St, Tyler, MN 56178 | 2006-05-18 |
| 1285687004 | Luann Elizabeth Weber | Physician Assistant | 240 Willow St., Tyler, MN 56178-0240 | 2006-05-19 |
| 1649223439 | Avera Tyler | Clinic/Center | 240 Willow St, Tyler, MN 56178-0240 | 2006-05-19 |
| Find all providers in zip 56178 | ||||
| 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 |
|---|---|---|---|---|
| 1912504572 | Paul Glenn Swinney IIi | Dentist | 5613 Donnybrook Ave, Tyler, TX 75703-6111 | 2020-10-07 |
| 1447878756 | Nathan William Guess | Dentist | 3905 University Blvd Ste 200, Tyler, TX 75701-6610 | 2020-07-13 |
| 1871090860 | Dylan Patrick Dds, Pllc | Dentist | 419 W Sw Loop 323 Ste 300, Tyler, TX 75701-7062 | 2018-04-07 |
| 1356896229 | Bryan Sendelbach | Dentist | 3800 Southpark Dr, Tyler, TX 75703-1713 | 2016-08-22 |
| 1235500752 | Sachin V Kocharekar | Dentist | 3310 S Southwest Loop 323, Tyler, TX 75701-9236 | 2015-10-09 |
| 1538555370 | Rose Dental Care of Tyler | Dentist | 5111 Troup Hwy, 100, Tyler, TX 75707-1919 | 2015-04-08 |
| 1275939902 | Henry Trammell | Dentist | 504 S Spring Ave, Tyler, TX 75702-8140 | 2014-11-06 |
| 1275955486 | Rice Road Dental Associates, P.a. | Dentist | 5613 S Donnybrook Ave, Tyler, TX 75703 | 2014-01-08 |
| 1629499710 | Donald A. Allen D.d.s. | Dentist | 601 E Dodge St, Tyler, TX 75701-1812 | 2013-12-17 |
| 1346671336 | Dennis Keith Johnson | Dentist | 3081 Hwy. 31 East, Tyler, TX 75702 | 2013-12-02 |
| Find all providers in TYLER | ||||
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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.