Provider Demographics
NPI:1568792091
Name:ANDERSEN FAMILY DENTISTRY PC
Entity Type:Organization
Organization Name:ANDERSEN FAMILY DENTISTRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JORGEN
Authorized Official - Last Name:ANDERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-444-6811
Mailing Address - Street 1:186 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:NH
Mailing Address - Zip Code:03561-4014
Mailing Address - Country:US
Mailing Address - Phone:603-444-6811
Mailing Address - Fax:603-444-7052
Practice Address - Street 1:186 MAIN ST
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:NH
Practice Address - Zip Code:03561-4014
Practice Address - Country:US
Practice Address - Phone:603-444-6811
Practice Address - Fax:603-444-7052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-06
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHNH031571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty