Provider Demographics
NPI:1619045440
Name:ANDERSON, DALE MARSHALL (D D S, M S)
Entity Type:Individual
Prefix:DR
First Name:DALE
Middle Name:MARSHALL
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:D D S, M S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 E WOODFIELD RD
Mailing Address - Street 2:SUITE 520
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-5905
Mailing Address - Country:US
Mailing Address - Phone:847-605-8880
Mailing Address - Fax:847-605-8901
Practice Address - Street 1:1701 E WOODFIELD RD
Practice Address - Street 2:SUITE 520
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-5905
Practice Address - Country:US
Practice Address - Phone:847-605-8880
Practice Address - Fax:847-605-8901
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL21-S9731223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics