Provider Demographics
NPI:1336259175
Name:ANDERSON, MARY S (MSN DDS)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:S
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MSN DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11305 ASH
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1643
Mailing Address - Country:US
Mailing Address - Phone:913-649-5017
Mailing Address - Fax:913-661-7186
Practice Address - Street 1:11305 ASH
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66211-1643
Practice Address - Country:US
Practice Address - Phone:913-649-5017
Practice Address - Fax:913-661-7186
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS6890122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist