Provider Demographics
NPI:1548823354
Name:WIMMERGREN, ANDREA (DDS)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:WIMMERGREN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14061 SAINT FRANCIS BLVD
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:MN
Mailing Address - Zip Code:55303-4692
Mailing Address - Country:US
Mailing Address - Phone:763-576-1855
Mailing Address - Fax:
Practice Address - Street 1:14061 SAINT FRANCIS BLVD
Practice Address - Street 2:
Practice Address - City:RAMSEY
Practice Address - State:MN
Practice Address - Zip Code:55303-4692
Practice Address - Country:US
Practice Address - Phone:763-576-1855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-17
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND142141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice