Provider Demographics
NPI:1275755605
Name:ANDERSON, AARON M (DDS)
Entity Type:Individual
Prefix:DR
First Name:AARON
Middle Name:M
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 1:1308 BRADLEY CT
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:IL
Mailing Address - Zip Code:61081-4301
Mailing Address - Country:US
Mailing Address - Phone:815-626-4194
Mailing Address - Fax:
Practice Address - Street 1:1835 1ST AVE
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:IL
Practice Address - Zip Code:61081-1201
Practice Address - Country:US
Practice Address - Phone:815-626-9600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice