Provider Demographics
NPI:1679352009
Name:LORI K ANDERSON DDS PLLC
Entity Type:Organization
Organization Name:LORI K ANDERSON DDS PLLC
Other - Org Name:ANDERSON DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:K
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:623-455-9179
Mailing Address - Street 1:2525 W CAREFREE HWY STE 108
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085-6095
Mailing Address - Country:US
Mailing Address - Phone:623-455-9179
Mailing Address - Fax:
Practice Address - Street 1:2525 W CAREFREE HWY STE 108
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85085-6095
Practice Address - Country:US
Practice Address - Phone:623-455-9179
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Multi-Specialty