Provider Demographics
NPI:1467729020
Name:CHARLES C. ANDERSON D.D.S. S.C.
Entity Type:Organization
Organization Name:CHARLES C. ANDERSON D.D.S. S.C.
Other - Org Name:ROBERT J. SCHWEITZER D.D.S.S.C.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:C
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:414-425-2900
Mailing Address - Street 1:7218 S. 76TH STREET
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132-9041
Mailing Address - Country:US
Mailing Address - Phone:414-425-2900
Mailing Address - Fax:414-425-2901
Practice Address - Street 1:7218 S. 76TH STREET
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:WI
Practice Address - Zip Code:53132-9041
Practice Address - Country:US
Practice Address - Phone:414-425-2900
Practice Address - Fax:414-425-2901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-28
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty