Provider Demographics
NPI:1598773814
Name:ANDERSEN, WILLIAM CLARK (DDS)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:CLARK
Last Name:ANDERSEN
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 1:111 E FOREST ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:BRIGHAM CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84302-2127
Mailing Address - Country:US
Mailing Address - Phone:435-723-3272
Mailing Address - Fax:435-734-9339
Practice Address - Street 1:111 E FOREST ST
Practice Address - Street 2:SUITE C
Practice Address - City:BRIGHAM CITY
Practice Address - State:UT
Practice Address - Zip Code:84302-2127
Practice Address - Country:US
Practice Address - Phone:435-723-3272
Practice Address - Fax:435-734-9339
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT144759-99211223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics