Provider Demographics
NPI:1053311951
Name:ANDERSON, ROBERT RAY (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:RAY
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 1:155 COOK ST
Mailing Address - Street 2:STE 251
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-5325
Mailing Address - Country:US
Mailing Address - Phone:303-321-1323
Mailing Address - Fax:303-321-1147
Practice Address - Street 1:155 COOK ST
Practice Address - Street 2:STE 251
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-5325
Practice Address - Country:US
Practice Address - Phone:303-321-1323
Practice Address - Fax:303-321-1147
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3430122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist