Provider Demographics
NPI:1477831766
Name:ANDERTON DENTAL GROUP
Entity type:Organization
Organization Name:ANDERTON DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLFE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-621-1835
Mailing Address - Street 1:1220 33RD ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-1378
Mailing Address - Country:US
Mailing Address - Phone:801-621-1835
Mailing Address - Fax:801-621-1848
Practice Address - Street 1:1220 33RD ST
Practice Address - Street 2:SUITE A
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-1378
Practice Address - Country:US
Practice Address - Phone:801-621-1835
Practice Address - Fax:801-621-1848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-03
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT62420011223G0001X
UT80294961223G0001X
UT1373081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty