Provider Demographics
NPI:1679693089
Name:ANDERSON DENTAL DDS PC
Entity Type:Organization
Organization Name:ANDERSON DENTAL DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:816-478-0909
Mailing Address - Street 1:823 NE LAKEWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64064-1366
Mailing Address - Country:US
Mailing Address - Phone:816-478-0909
Mailing Address - Fax:816-373-1181
Practice Address - Street 1:823 NE LAKEWOOD BLVD
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64064-1366
Practice Address - Country:US
Practice Address - Phone:816-478-0909
Practice Address - Fax:816-373-1181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
24264041OtherBCBS SERVING NUMBER