Provider Demographics
NPI:1871684712
Name:ANDERSON, STEVE PHILIP (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEVE
Middle Name:PHILIP
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 1:4801 MONTANO RD NW
Mailing Address - Street 2:STE A-3
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-2428
Mailing Address - Country:US
Mailing Address - Phone:505-898-4504
Mailing Address - Fax:505-899-0525
Practice Address - Street 1:4801 MONTANO RD NW
Practice Address - Street 2:STE A-3
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-2428
Practice Address - Country:US
Practice Address - Phone:505-898-4504
Practice Address - Fax:505-899-0525
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM15161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice