Provider Demographics
NPI:1144234261
Name:ANDERSON, TONYA M (DDS)
Entity Type:Individual
Prefix:DR
First Name:TONYA
Middle Name:M
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3719 RIVERDALE RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38115-5322
Mailing Address - Country:US
Mailing Address - Phone:901-365-2000
Mailing Address - Fax:901-365-2626
Practice Address - Street 1:3719 RIVERDALE RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38115-5322
Practice Address - Country:US
Practice Address - Phone:901-365-2000
Practice Address - Fax:901-365-2626
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS0000006961122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1453674OtherPROVIDER-UNITED CONCORDIA
4074188OtherPROVIDER BCBS