Provider Demographics
NPI:1649375387
Name:ANDERSON, JOHN H (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:H
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 1:2011 WESTCLIFF DR
Mailing Address - Street 2:SUITE 11
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-5599
Mailing Address - Country:US
Mailing Address - Phone:949-722-7722
Mailing Address - Fax:949-722-7744
Practice Address - Street 1:2011 WESTCLIFF DR
Practice Address - Street 2:SUITE 11
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-5599
Practice Address - Country:US
Practice Address - Phone:949-722-7722
Practice Address - Fax:949-722-7744
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38022122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFHC70520FMedicaid
CA551878Medicare ID - Type Unspecified