Provider Demographics
NPI:1073693636
Name:ANDERSEN, PHILIP NELS (DDS)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:NELS
Last Name:ANDERSEN
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 1:907 BANK CT
Mailing Address - Street 2:
Mailing Address - City:CENTER POINT
Mailing Address - State:IA
Mailing Address - Zip Code:52213-9337
Mailing Address - Country:US
Mailing Address - Phone:319-849-1171
Mailing Address - Fax:319-849-2453
Practice Address - Street 1:907 BANK CT
Practice Address - Street 2:
Practice Address - City:CENTER POINT
Practice Address - State:IA
Practice Address - Zip Code:52213-9337
Practice Address - Country:US
Practice Address - Phone:319-849-1171
Practice Address - Fax:319-849-2453
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA68011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice