Provider Demographics
NPI:1821384785
Name:CHAD J. ANDERSON D.M.D. INC
Entity Type:Organization
Organization Name:CHAD J. ANDERSON D.M.D. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:J
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:559-434-1096
Mailing Address - Street 1:9497 N FORT WASHINGTON RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93730-0606
Mailing Address - Country:US
Mailing Address - Phone:559-434-1096
Mailing Address - Fax:559-434-1799
Practice Address - Street 1:9497 N. FORT WASHINGTON RD.
Practice Address - Street 2:SUITE 106
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93730
Practice Address - Country:US
Practice Address - Phone:559-434-1088
Practice Address - Fax:559-434-1799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-20
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52822122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty