Provider Demographics
NPI:1851848873
Name:DAVID P ANDERSON DDS PLLC
Entity Type:Organization
Organization Name:DAVID P ANDERSON DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:970-422-8498
Mailing Address - Street 1:555 RIVERGATE
Mailing Address - Street 2:B1-109
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-7470
Mailing Address - Country:US
Mailing Address - Phone:970-422-8498
Mailing Address - Fax:
Practice Address - Street 1:555 RIVERGATE
Practice Address - Street 2:B1-109
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-7470
Practice Address - Country:US
Practice Address - Phone:970-422-8498
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-07
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.00202432122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1144438946OtherNPI