Provider Demographics
NPI:1780690065
Name:ANDERSON, BOB E (DDS)
Entity Type:Individual
Prefix:DR
First Name:BOB
Middle Name:E
Last Name:ANDERSON
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Gender:M
Credentials:DDS
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Mailing Address - Street 1:1 SAINT VINCENT CIR
Mailing Address - Street 2:#240
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-5405
Mailing Address - Country:US
Mailing Address - Phone:501-664-3900
Mailing Address - Fax:501-663-6076
Practice Address - Street 1:1 SAINT VINCENT CIR
Practice Address - Street 2:#240
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5405
Practice Address - Country:US
Practice Address - Phone:501-664-3900
Practice Address - Fax:501-663-6076
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
AR17291223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ART20342Medicare UPIN