Provider Demographics
NPI:1144206863
Name:WANDERA, R ANGELA (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:R
Middle Name:ANGELA
Last Name:WANDERA
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Gender:F
Credentials:DDS, MS
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Mailing Address - Street 1:8785 COLUMBINE RD
Mailing Address - Street 2:ANDERSON LAKES CENTER
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-6695
Mailing Address - Country:US
Mailing Address - Phone:952-941-7393
Mailing Address - Fax:952-941-2162
Practice Address - Street 1:8785 COLUMBINE RD
Practice Address - Street 2:ANDERSON LAKES CENTER
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-6695
Practice Address - Country:US
Practice Address - Phone:952-941-7393
Practice Address - Fax:952-941-2162
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-15
Last Update Date:2025-09-11
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Provider Licenses
StateLicense IDTaxonomies
MND116181223P0221X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN15212OtherDORAL
MN261084100OtherMHCP