Provider Demographics
NPI:1245400738
Name:ANDERSON, DOUGLAS TAYLOR (DDS)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:TAYLOR
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 1:552 S WASHINGTON ST
Mailing Address - Street 2:SUITE 220
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-6670
Mailing Address - Country:US
Mailing Address - Phone:630-357-2525
Mailing Address - Fax:
Practice Address - Street 1:552 S WASHINGTON ST
Practice Address - Street 2:SUITE 220
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-6658
Practice Address - Country:US
Practice Address - Phone:630-357-2525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-11
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019018954122300000X, 1223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223D0001XDental ProvidersDentistDental Public Health