Provider Demographics
NPI:1467583823
Name:ANDERSON, HENRIK L (DDS)
Entity Type:Individual
Prefix:
First Name:HENRIK
Middle Name:L
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 1:2000 WINDSOR ROAD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22307
Mailing Address - Country:US
Mailing Address - Phone:703-329-8488
Mailing Address - Fax:
Practice Address - Street 1:269B PENINSULA FARM ROAD
Practice Address - Street 2:BROADNECK MEDICAL CENTER
Practice Address - City:ARNOLD
Practice Address - State:MD
Practice Address - Zip Code:21012
Practice Address - Country:US
Practice Address - Phone:410-923-6866
Practice Address - Fax:410-544-4621
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD109301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice