Provider Demographics
NPI:1770669541
Name:ANDERSON, RALPH HB (DR)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:HB
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:DR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5500 MONUMENT AVE
Mailing Address - Street 2:SUITE K
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-1452
Mailing Address - Country:US
Mailing Address - Phone:804-285-9800
Mailing Address - Fax:804-285-5711
Practice Address - Street 1:5500 MONUMENT AVE
Practice Address - Street 2:SUITE K
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-1452
Practice Address - Country:US
Practice Address - Phone:804-285-9800
Practice Address - Fax:804-285-5711
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010087491223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9183338OtherDORAL-VA MC DENTAL
VA9183338Medicaid