Provider Demographics
NPI:1205195781
Name:ANDERSON, MICHAEL DAVID (DDS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DAVID
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 1:2409 LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-3157
Mailing Address - Country:US
Mailing Address - Phone:301-512-5401
Mailing Address - Fax:
Practice Address - Street 1:1062 E HIGH STREET
Practice Address - Street 2:SUITE 301
Practice Address - City:OAKLAND
Practice Address - State:MD
Practice Address - Zip Code:21550
Practice Address - Country:US
Practice Address - Phone:301-334-4485
Practice Address - Fax:301-334-4714
Is Sole Proprietor?:No
Enumeration Date:2012-05-03
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD153031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice