Provider Demographics
NPI:1851446405
Name:ANDERSON, STEVEN E (DDS, PA)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:E
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:DDS, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 S DIVISION AVE
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-2710
Mailing Address - Country:US
Mailing Address - Phone:208-263-7597
Mailing Address - Fax:208-263-8845
Practice Address - Street 1:311 S DIVISION AVE
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-2710
Practice Address - Country:US
Practice Address - Phone:208-263-7597
Practice Address - Fax:208-263-8845
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD 19701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1970OtherDELTA
ID62539OtherBCBS
ID48148OtherBS
ID820487001OtherFED TAX ID
ID48148OtherBS#
ID6253-9OtherBX
IDD 1970OtherLICENSE
IDD 1970OtherLICENSE