Provider Demographics
NPI:1376814178
Name:ANDERSEN, DANE (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANE
Middle Name:
Last Name:ANDERSEN
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 1:9819 SE 18TH CIR
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98664-3742
Mailing Address - Country:US
Mailing Address - Phone:425-346-0288
Mailing Address - Fax:
Practice Address - Street 1:2415 NE 134TH ST STE 307
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-3029
Practice Address - Country:US
Practice Address - Phone:360-567-3333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-25
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010205331223G0001X
WA605554431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice