Provider Demographics
NPI:1417113572
Name:ANDERSON, JOAN ISABELL (DDS)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:ISABELL
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1971 EVELYN BYRD AVE STE F
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-3477
Mailing Address - Country:US
Mailing Address - Phone:540-705-0102
Mailing Address - Fax:540-705-0102
Practice Address - Street 1:1971 EVELYN BYRD AVE STE F
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801
Practice Address - Country:US
Practice Address - Phone:540-705-0102
Practice Address - Fax:540-705-0102
Is Sole Proprietor?:No
Enumeration Date:2008-07-29
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401413162122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0401413162OtherSTATE DENTAL LICENSE