Provider Demographics
NPI:1134265655
Name:MORGAN L ANDERSEN, DDS, PS
Entity type:Organization
Organization Name:MORGAN L ANDERSEN, DDS, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PATIENT SPECIALIST
Authorized Official - Prefix:MS
Authorized Official - First Name:KENDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHANK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-256-8200
Mailing Address - Street 1:12116 SE MILL PLAIN BLVD
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-6000
Mailing Address - Country:US
Mailing Address - Phone:360-256-8200
Mailing Address - Fax:360-256-9356
Practice Address - Street 1:12116 SE MILL PLAIN BLVD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-6000
Practice Address - Country:US
Practice Address - Phone:360-256-8200
Practice Address - Fax:360-256-9356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA6032122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty