Provider Demographics
NPI:1861653123
Name:ANDERSON, BARBARA JOANNE (DMD)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:JOANNE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1628 29TH CT. S
Mailing Address - Street 2:#200
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209
Mailing Address - Country:US
Mailing Address - Phone:205-538-3335
Mailing Address - Fax:205-614-8775
Practice Address - Street 1:1628 29TH CT. S
Practice Address - Street 2:#200
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209
Practice Address - Country:US
Practice Address - Phone:205-538-3335
Practice Address - Fax:205-614-8775
Is Sole Proprietor?:No
Enumeration Date:2008-06-19
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AL5631122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program