Provider Demographics
NPI:1093025785
Name:ANDERSON, WILLIAM STANLEY (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:STANLEY
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 1:2602 VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-2511
Mailing Address - Country:US
Mailing Address - Phone:219-962-8586
Mailing Address - Fax:219-242-8305
Practice Address - Street 1:2602 VALLEY DR
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-2511
Practice Address - Country:US
Practice Address - Phone:219-962-8586
Practice Address - Fax:219-242-8305
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-14
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009651122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist