Provider Demographics
NPI:1689781882
Name:ANDERSON, JAMES BENSON
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:BENSON
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1019 11TH ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:NE
Mailing Address - Zip Code:68818
Mailing Address - Country:US
Mailing Address - Phone:402-694-6466
Mailing Address - Fax:402-694-6465
Practice Address - Street 1:1019 11TH ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:NE
Practice Address - Zip Code:68818
Practice Address - Country:US
Practice Address - Phone:402-694-6466
Practice Address - Fax:402-694-6465
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4074122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47054962700Medicaid