Provider Demographics
NPI:1376599373
Name:CLIFFORD V ANDERSON DDS AND ASSOCIATES INC
Entity Type:Organization
Organization Name:CLIFFORD V ANDERSON DDS AND ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CLIFFORD
Authorized Official - Middle Name:VIRGIL
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:816-353-7200
Mailing Address - Street 1:4240 BLUE RIDGE BLVD
Mailing Address - Street 2:SUITE 800
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64133-1713
Mailing Address - Country:US
Mailing Address - Phone:816-353-7200
Mailing Address - Fax:816-353-5162
Practice Address - Street 1:4240 BLUE RIDGE BLVD
Practice Address - Street 2:SUITE 800
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64133
Practice Address - Country:US
Practice Address - Phone:816-353-7200
Practice Address - Fax:816-353-5162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty