Provider Demographics
NPI:1558498188
Name:ANDERSON, PATRICK S JR
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:S
Last Name:ANDERSON
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 N CRAYCROFT RD
Mailing Address - Street 2:STE 1
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-2808
Mailing Address - Country:US
Mailing Address - Phone:520-298-4270
Mailing Address - Fax:520-733-6156
Practice Address - Street 1:2300 N CRAYCROFT RD
Practice Address - Street 2:STE 1
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2808
Practice Address - Country:US
Practice Address - Phone:520-298-4270
Practice Address - Fax:520-733-6156
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ19741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice