Provider Demographics
NPI:1093171977
Name:GREG A. ANDERSON, DDS,PC
Entity Type:Organization
Organization Name:GREG A. ANDERSON, DDS,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:A
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:701-577-2261
Mailing Address - Street 1:PO BOX 1127
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:ND
Mailing Address - Zip Code:58802-1127
Mailing Address - Country:US
Mailing Address - Phone:701-577-2261
Mailing Address - Fax:701-577-0737
Practice Address - Street 1:501 MAIN ST
Practice Address - Street 2:SUITE 4
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801-5327
Practice Address - Country:US
Practice Address - Phone:701-577-2261
Practice Address - Fax:701-577-0737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-08
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental