Provider Demographics
NPI:1801000468
Name:ANDERSON, DONALD LLOYD (DDS)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:LLOYD
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 1:6969 TALISMAN CT
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92119-1776
Mailing Address - Country:US
Mailing Address - Phone:619-469-1249
Mailing Address - Fax:619-469-1323
Practice Address - Street 1:6244 EL CAJON BLVD
Practice Address - Street 2:SUITE 8
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115-3918
Practice Address - Country:US
Practice Address - Phone:619-583-5400
Practice Address - Fax:619-583-5983
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA221931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice