Provider Demographics
NPI:1386841559
Name:ROBERT ANDERSON DENTAL CORP
Entity Type:Organization
Organization Name:ROBERT ANDERSON DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSD
Authorized Official - Phone:707-422-2190
Mailing Address - Street 1:3694 HILBORN RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-7988
Mailing Address - Country:US
Mailing Address - Phone:707-422-2190
Mailing Address - Fax:
Practice Address - Street 1:3694 HILBORN RD
Practice Address - Street 2:SUITE 202
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534-7988
Practice Address - Country:US
Practice Address - Phone:707-422-2190
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA395081223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty