Provider Demographics
NPI:1710052691
Name:THOMAS W. ANDERSON
Entity Type:Organization
Organization Name:THOMAS W. ANDERSON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:GERARD
Authorized Official - Last Name:BATTAGLIA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:763-757-1234
Mailing Address - Street 1:11237 FOLEY BLVD. NW
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55448
Mailing Address - Country:US
Mailing Address - Phone:763-757-3120
Mailing Address - Fax:763-757-5161
Practice Address - Street 1:11237 FOLEY BLVD. NW
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55448
Practice Address - Country:US
Practice Address - Phone:763-757-3120
Practice Address - Fax:763-757-5161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-23
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
122300000X
MN70541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty