Provider Demographics
NPI:1265449995
Name:ANDERSON, ROBERT C (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:C
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4206 EAST LAKE RD
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16511-1357
Mailing Address - Country:US
Mailing Address - Phone:814-899-0602
Mailing Address - Fax:814-898-0990
Practice Address - Street 1:4206 EAST LAKE RD
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16511-1357
Practice Address - Country:US
Practice Address - Phone:814-899-0602
Practice Address - Fax:814-898-0990
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS016944L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist