ANNALISE WALLERICH (NPI# 1033729033) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1033729033 |
| Entity Type | Individual |
| Full Name | ANNALISE WALLERICH |
| Credential | RDH, DT |
| Practice Address |
2232 Hennepin Ave Minneapolis MN 55405-2737 |
| Practice Telephone | 6123776108 |
| Mailing Telephone | 6123776108 |
| Enumeration Date | 2020-08-04 |
| Last Update Date | 2020-08-04 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 125J00000X | Dental Therapist | DT134 | MN | Dental Providers |
| Street Address |
2232 HENNEPIN AVE |
| City | MINNEAPOLIS |
| State | MN |
| Zip Code | 55405-2737 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558383679 | Adele Della Torre | Dentist | 2232 Hennepin Ave, Minneapolis, MN 55405-2737 | 2006-07-25 |
| 1679962708 | Verny Martinez | Dental Therapist | 2232 Hennepin Ave, Minneapolis, MN 55405-2737 | 2015-01-13 |
| 1679911531 | Adt Kids Dental Services Pa | Dentist | 2232 Hennepin Ave, Minneapolis, MN 55405-2737 | 2013-06-12 |
| 1659393783 | Alice M. Ottavi | Dentist | 2232 Hennepin Ave, Minneapolis, MN 55405-2737 | 2006-07-25 |
| 1548282585 | Adt Dental, Ltd. | Dentist | 2232 Hennepin Ave, Minneapolis, MN 55405-2737 | 2006-07-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003373689 | Minneapolis Health & Wellness Ne, LLC | Physical Therapist | 2125 E Hennepin Ave, Suite 300, Minneapolis, MN 55405 | 2019-03-01 |
| 1033673967 | Amy Fitzgerald | Counselor | 2915 South Wayzata Boulevard, Minneapolis, MN 55405 | 2019-01-24 |
| 1861975245 | Sara Tejani | Dentist | 2232 Hennepin Ave. S., Minneapolis, MN 55405 | 2018-09-11 |
| 1477903995 | James Albert Zeese Jr. | Psychiatry & Neurology | 2401 Laurel Avenue, Minneapolis, MN 55405 | 2016-06-15 |
| 1154786523 | Sophia Bouwens | Acupuncturist | 275 Market St Ste 409, Minneapolis, MN 55405 | 2015-12-29 |
| 1912362732 | Anna Needham | Acupuncturist | 2200 Hennepin Ave S, Minneapolis, MN 55405 | 2015-12-21 |
| 1821423740 | Aja Dionna King | Counselor | 227 Colfax Ave N Ste 15, Minneapolis, MN 55405 | 2013-09-10 |
| 1013280403 | Walgreen Co. | Durable Medical Equipment & Medical Supplies | 2100 Lyndale Ave S Ste A, Minneapolis, MN 55405 | 2012-02-15 |
| 1396022117 | Sharri Peterson Rogers | Marriage & Family Therapist | 2809 South Wayzata Blvd, Minneapolis, MN 55405 | 2011-11-08 |
| 1447577143 | Kareem Shareef Braxton | Counselor | 227 Colfax Avenue North, Suite 130, Minneapolis, MN 55405 | 2010-04-21 |
| Find all providers in zip 55405 | ||||
| Taxonomy Code | 125J00000X |
| Grouping | Dental Providers |
| Classification | Dental Therapist |
| A Dental Therapist is an individual who has completed an accredited or non-accredited dental therapy program and who has been authorized by the relevant state board or a tribal entity to provide services within the scope of their practice under the supervision of a dentist. Functions that may be delegated to the dental therapist vary based on the needs of the dentist, the educational preparation of the dental therapist and state dental practice acts and regulations. |
| Notes: Source: Summarized from Minnesota Statute 150A.105. [7/1/2012: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003230137 | Janelle Jehn | Dental Therapist | 4342 4th Ave S, Minneapolis, MN 55409-2155 | 2014-02-10 |
| 1568074607 | Abdulkadir Egeh | Dental Therapist | 636 Broadway St Ne, Minneapolis, MN 55413-2164 | 2020-08-19 |
| 1679033252 | Sheli Kaye Parkison | Dental Therapist | 4243 4th Ave S, Minneapolis, MN 55409-2113 | 2019-03-21 |
| 1386146942 | Julie Marie Klemond | Dental Therapist | 2001 Bloomington Ave, Minneapolis, MN 55404-3074 | 2018-02-28 |
| 1073013322 | Nicole Mathew | Dental Therapist | 636 Broadway St Ne, Minneapolis, MN 55413-2164 | 2018-02-13 |
| 1134637143 | Lucky Vang | Dental Therapist | 2228 E Lake St, Minneapolis, MN 55407-4321 | 2018-01-12 |
| 1891233748 | Jenny Meyers | Dental Therapist | 4243 4th Ave S, Minneapolis, MN 55409-2113 | 2017-02-10 |
| 1679962708 | Verny Martinez | Dental Therapist | 2232 Hennepin Ave, Minneapolis, MN 55405-2737 | 2015-01-13 |
| 1114315678 | Teresa Bushnell | Dental Therapist | 636 Broadway St Ne, Minneapolis, MN 55413-2164 | 2015-01-06 |
| 1124416789 | Trina Courtright | Dental Therapist | 636 Broadway St Ne, Minneapolis, MN 55413-2164 | 2015-01-06 |
| Find all providers in MINNEAPOLIS | ||||
| City | MINNEAPOLIS |
| Zip Code | 55405 |
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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.