Provider Demographics
NPI:1467867580
Name:DEVIN ANDERSON D,D.S.
Entity Type:Organization
Organization Name:DEVIN ANDERSON D,D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST ANESTHESIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DEVIN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:D,DS
Authorized Official - Phone:909-496-1718
Mailing Address - Street 1:11261 WAREHAM CT
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-4875
Mailing Address - Country:US
Mailing Address - Phone:909-496-1718
Mailing Address - Fax:909-478-0778
Practice Address - Street 1:11261 WAREHAM CT
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-4875
Practice Address - Country:US
Practice Address - Phone:909-496-1718
Practice Address - Fax:909-478-0778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-26
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46353261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA520882Medicare PIN