Provider Demographics
NPI:1144215112
Name:ANDERSON, ALFRED WILLIAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALFRED
Middle Name:WILLIAM
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 1:223 SUNSET BLVD
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-2630
Mailing Address - Country:US
Mailing Address - Phone:507-387-7186
Mailing Address - Fax:
Practice Address - Street 1:1211 CALEDONIA ST
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-4329
Practice Address - Country:US
Practice Address - Phone:507-345-5138
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN60021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice