Provider Demographics
NPI:1255459343
Name:ANDERSON, CRAIG WILLIAM (DDS)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:WILLIAM
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 1:2080 CENTURY PARK EAST
Mailing Address - Street 2:#1710
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90067-2020
Mailing Address - Country:US
Mailing Address - Phone:310-553-3232
Mailing Address - Fax:
Practice Address - Street 1:2080 CENTURY PARK EAST
Practice Address - Street 2:#1710
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90067-2020
Practice Address - Country:US
Practice Address - Phone:310-553-3232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA450831223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics