Provider Demographics
NPI:1497042725
Name:ANDERSON, ERIC PAUL (DDS)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:PAUL
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 1:20971 E SMOKY HILL RD STE 202
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80015-5187
Mailing Address - Country:US
Mailing Address - Phone:303-400-1100
Mailing Address - Fax:303-400-4422
Practice Address - Street 1:20971 E SMOKY HILL RD STE 202
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80015-5187
Practice Address - Country:US
Practice Address - Phone:303-400-1100
Practice Address - Fax:303-400-4422
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-07
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO104881223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics