Provider Demographics
NPI:1275739252
Name:ANDERTON, JOCELYN LEE (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOCELYN
Middle Name:LEE
Last Name:ANDERTON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:432 ROLLING RIDGE DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-7640
Mailing Address - Country:US
Mailing Address - Phone:814-231-2023
Mailing Address - Fax:814-237-5245
Practice Address - Street 1:432 ROLLING RIDGE DR
Practice Address - Street 2:SUITE 1
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-7640
Practice Address - Country:US
Practice Address - Phone:814-231-2023
Practice Address - Fax:814-237-5245
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS037191122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist