Provider Demographics
NPI:1366831547
Name:ANDERSON DENTAL ASSOCIATES PC
Entity Type:Organization
Organization Name:ANDERSON DENTAL ASSOCIATES PC
Other - Org Name:POTTSVILLE DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:570-795-9560
Mailing Address - Street 1:112 E PROVIDENCE RD
Mailing Address - Street 2:
Mailing Address - City:ALDAN
Mailing Address - State:PA
Mailing Address - Zip Code:19018-4127
Mailing Address - Country:US
Mailing Address - Phone:570-795-9560
Mailing Address - Fax:570-516-9145
Practice Address - Street 1:315 W MARKET ST
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-4066
Practice Address - Country:US
Practice Address - Phone:570-795-9560
Practice Address - Fax:570-516-9145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-12
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS026658L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty