Provider Demographics
NPI:1497594188
Name:ANDERSON, BRIANNA MARIE (DDS)
Entity type:Individual
Prefix:DR
First Name:BRIANNA
Middle Name:MARIE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 E OAKLAND ST
Mailing Address - Street 2:
Mailing Address - City:SAINT ROSE
Mailing Address - State:LA
Mailing Address - Zip Code:70087-3230
Mailing Address - Country:US
Mailing Address - Phone:504-644-0060
Mailing Address - Fax:
Practice Address - Street 1:40470 GERMANY RD
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-6735
Practice Address - Country:US
Practice Address - Phone:225-622-2022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-22
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA75211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice