Provider Demographics
NPI:1639238504
Name:ANDERSON, DENIS DAVID (DDS)
Entity Type:Individual
Prefix:DR
First Name:DENIS
Middle Name:DAVID
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 1:1211 CURRENCY CT
Mailing Address - Street 2:SUITE 3
Mailing Address - City:ROCHELLE
Mailing Address - State:IL
Mailing Address - Zip Code:61068-2322
Mailing Address - Country:US
Mailing Address - Phone:815-562-8774
Mailing Address - Fax:815-561-8150
Practice Address - Street 1:1211 CURRENCY CT
Practice Address - Street 2:SUITE 3
Practice Address - City:ROCHELLE
Practice Address - State:IL
Practice Address - Zip Code:61068-2322
Practice Address - Country:US
Practice Address - Phone:815-562-8774
Practice Address - Fax:815-561-8150
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL190144541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice