Provider Demographics
NPI:1720180235
Name:ANDERSON, SAMUEL P (DDS)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:P
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 1:271 S PINE ST
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29302-2626
Mailing Address - Country:US
Mailing Address - Phone:864-585-5246
Mailing Address - Fax:864-585-5342
Practice Address - Street 1:271 S PINE ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29302-2626
Practice Address - Country:US
Practice Address - Phone:864-585-5246
Practice Address - Fax:864-585-5342
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice