Provider Demographics
NPI:1407867328
Name:CHRISTOPHER M ANDERSON DMD LLC
Entity Type:Organization
Organization Name:CHRISTOPHER M ANDERSON DMD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:770-973-6494
Mailing Address - Street 1:1225 JOHNSON FERRY RD
Mailing Address - Street 2:SUITE #660
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-2727
Mailing Address - Country:US
Mailing Address - Phone:770-973-6494
Mailing Address - Fax:770-973-6544
Practice Address - Street 1:1225 JOHNSON FERRY RD
Practice Address - Street 2:SUITE #660
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-2727
Practice Address - Country:US
Practice Address - Phone:770-973-6494
Practice Address - Fax:770-973-6544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0120011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty