Provider Demographics
NPI:1922010750
Name:ANDERSON, ANDREW RICHARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:RICHARD
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 1:3939 W 50TH ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55424-1244
Mailing Address - Country:US
Mailing Address - Phone:952-922-5561
Mailing Address - Fax:952-922-8214
Practice Address - Street 1:3939 W 50TH ST
Practice Address - Street 2:SUITE 210
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55424-1244
Practice Address - Country:US
Practice Address - Phone:952-922-5561
Practice Address - Fax:952-922-8214
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND93251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice