Provider Demographics
NPI:1922258474
Name:ANDERSON, DENNIS LEE (DO)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:LEE
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5221 VILLAGE RUN AVE
Mailing Address - Street 2:UNIT 1602
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50317-4979
Mailing Address - Country:US
Mailing Address - Phone:515-266-1992
Mailing Address - Fax:
Practice Address - Street 1:5221 VILLAGE RUN AVE
Practice Address - Street 2:UNIT 1602
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50317-4979
Practice Address - Country:US
Practice Address - Phone:515-266-1992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-21
Last Update Date:2008-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01468207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine