| Doctor Name: | DR. R ANGELA WANDERA |
| NPI Number: | 1144206863 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | DDS, MS |
| License Number: | D11618 |
| Business Practice Address: | 8785 Columbine Rd Anderson Lakes Center Eden Prairie, MN - 553446695 |
| Business Phone Number: | 9529417393 |
| Business Fax Number: | 9529412162 |
| Mailing Address: | 8785 Columbine Rd, Anderson Lakes Center EDEN PRAIRIE |
| State: | MN |
| Postal Code: | 553446695 |
| Phone Number: | 9529417393 |
| Fax Number: | 9529412162 |
| NPI Enumeration Date: | 12/15/2005 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1223P0221X |
| License Number: | D11618 |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | MN |
| Taxonomy Type: | Dental Providers |
| Taxonomy Classification: | Dentist |
| Taxonomy Specialization: | Pediatric Dentistry |
| Taxonomy Definition: | An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |