Provider Demographics
NPI:1457466807
Name:ANDERSON, CHRISTOPHER DEAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:DEAN
Last Name:ANDERSON
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 1:1213 COFFEE RD
Mailing Address - Street 2:SUITE G
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-4229
Mailing Address - Country:US
Mailing Address - Phone:209-575-9501
Mailing Address - Fax:209-575-9502
Practice Address - Street 1:1213 COFFEE RD
Practice Address - Street 2:SUITE G
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-4229
Practice Address - Country:US
Practice Address - Phone:209-575-9501
Practice Address - Fax:209-575-9502
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA348141223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry