MEDICARE: ANDREA WIMMERGREN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	D14214	MN

General Provider Information

NPI Number	:	1548823354
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA WIMMERGREN DDS

Provider Business Mailing Address
First Line	:	14061 SAINT FRANCIS BLVD
Second Line	:
City	:	RAMSEY
State	:	MN
Zip	:	55303-4692
Country	:	US
Telephone Number	:	763-576-1855
Fax Number	:

Provider Business Practice Location Address
First Line	:	14061 SAINT FRANCIS BLVD
Second Line	:
City	:	RAMSEY
State	:	MN
Zip	:	55303-4692
Country	:	US
Telephone Number	:	763-576-1855
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/17/2019
Last Update Date	:	08/10/2022

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