Provider Demographics
NPI:1609485101
Name:ANDERSON, JUSTIN ALTON (DDS)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:ALTON
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 1:1595 COMMERCIAL ST SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-4309
Mailing Address - Country:US
Mailing Address - Phone:503-877-1598
Mailing Address - Fax:503-448-2560
Practice Address - Street 1:1595 COMMERCIAL ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-4309
Practice Address - Country:US
Practice Address - Phone:503-877-1598
Practice Address - Fax:503-448-2560
Is Sole Proprietor?:No
Enumeration Date:2020-07-30
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD112691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice