Provider Demographics
NPI:1215195771
Name:ANDERSON, GEOFFREY HAROLD (DDS)
Entity Type:Individual
Prefix:DR
First Name:GEOFFREY
Middle Name:HAROLD
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 1:581 N SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:CAMANO ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98282-7321
Mailing Address - Country:US
Mailing Address - Phone:360-387-9202
Mailing Address - Fax:
Practice Address - Street 1:581 N SUNSET DR
Practice Address - Street 2:
Practice Address - City:CAMANO ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98282-7321
Practice Address - Country:US
Practice Address - Phone:360-387-9202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-30
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA66581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice