Provider Demographics
NPI:1457571846
Name:ANDERSON, ROBERT EMMETT (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:EMMETT
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 1:4300 GOLDEN CENTER DR
Mailing Address - Street 2:SUITE G
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-6278
Mailing Address - Country:US
Mailing Address - Phone:530-622-9068
Mailing Address - Fax:530-622-9055
Practice Address - Street 1:4300 GOLDEN CENTER DR
Practice Address - Street 2:SUITE G
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-6278
Practice Address - Country:US
Practice Address - Phone:530-622-9068
Practice Address - Fax:530-622-9055
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA371931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice