Provider Demographics
NPI:1003813734
Name:ANDERSON, LONNIE ARTHUR (DDS)
Entity Type:Individual
Prefix:DR
First Name:LONNIE
Middle Name:ARTHUR
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 32498
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99803-2498
Mailing Address - Country:US
Mailing Address - Phone:907-789-2066
Mailing Address - Fax:907-789-2507
Practice Address - Street 1:9211 LEE SMITH DRIVE
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801
Practice Address - Country:US
Practice Address - Phone:907-789-2066
Practice Address - Fax:907-789-2507
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK8741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK920160884OtherFIN