=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144206863
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RUTH ANGELA WANDERA DDS, MS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/15/2005
-----------------------------------------------------
Last Update Date | 10/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8785 COLUMBINE RD ANDERSON LAKES CENTER
-----------------------------------------------------
City | EDEN PRAIRIE
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55344-6695
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 952-941-7393
-----------------------------------------------------
Fax | 952-941-2162
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8785 COLUMBINE RD ANDERSON LAKES CENTER
-----------------------------------------------------
City | EDEN PRAIRIE
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55344-6695
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 952-941-7393
-----------------------------------------------------
Fax | 952-941-2162
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number | D11618
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223P0221X
-----------------------------------------------------
Taxonomy Name | Pediatric Dentistry
-----------------------------------------------------
License Number | D11618
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------