MACY RUTH ANDERSON, D.D.S — NPI 1124641303 (Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD) in GLENDALE, WI)

CMS-1500 Box 24J / 33a • NPI

1124641303

Type 1 Individual Rendering/Ordering

HIPAA NUCC Taxonomy • CMS Code

1223G0001X (CMS C5)

Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD)

Box 32 Service Location & ZIP+4

5150 N PORT WASHINGTON RD STE 201, GLENDALE, WI, 53217-5400

✓ 9-Digit EDI 837 ZIP+4 (53217-5400)

Practice Phone & Referral Fax

(414) 964-8850

Direct NPPES Verification Line

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1124641303 (MACY RUTH ANDERSON, D.D.S) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

This practitioner does not currently appear in the CMS individual Order & Referring PECOS file (may practice in pediatrics, commercial-only networks, or hospital-employed settings).

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1124641303` (NPI-1 Individual Practitioner)
Provider / Legal Name	MACY RUTH ANDERSON, D.D.S
Plain-English Specialty	Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD) NUCC Code: `1223G0001X` (Dentist, General Practice)
Certifying / Licensing Body	American Dental Association (ADA) / State Board of Dental Examiners
Practice Location Address	5150 N PORT WASHINGTON RD STE 201, GLENDALE, WI, 53217-5400
Practice Telephone / Fax	Tel: (414) 964-8850
Administrative Mailing Address	5150 N PORT WASHINGTON RD STE 201, GLENDALE, WI, 53217-5400
Enumeration & Last Sync	Enumerated: 2020-05-22 \| CMS Record Updated: 2022-08-16

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

5150 N PORT WASHINGTON RD STE 201, GLENDALE, WI, 53217-5400

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Plain-English Taxonomy & CMS Crosswalk (1223G0001X)

What Does Taxonomy Code 1223G0001X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 1223G0001X translates to:
"Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD)"

CMS-1500 Medicare Specialty Crosswalk: CMS Code C5 (Dentist)
Certifying / Accrediting Authority: American Dental Association (ADA) / State Board of Dental Examiners
Clinical Scope: Routine 6-month dental checkups, toothache, dental abscess, bleeding gums (periodontitis), or wisdom tooth extraction.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (MACY RUTH ANDERSON, D.D.S)

Typical CPT / Diagnostic Procedures:

Comprehensive Oral Evaluation, Digital Dental Radiographs & Prophylaxis
Restorative Composite Fillings, Crowns, Endodontic Root Canal & Extractions

Common Therapeutic Classes:

Amoxicillin, Metronidazole & Clindamycin (Odontogenic Infections)
Chlorhexidine Gluconate 0.12% Oral Rinse & High-Fluoride Varnish

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`390200000X` — Student in an Organized Health Care Education/Training Program Plain English: Licensed & Credentialed Student in an Organized Health Care Education/Training Program	State: N/A \| License: `Verified` \| Primary: Secondary
`1223G0001X` — Dentist, General Practice Plain English: Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD)	State: WI \| License: `1002304` \| Primary: Yes (Primary)

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MACY RUTH ANDERSON, D.D.S (NPI #1124641303)