Provider Demographics
NPI:1649544842
Name:DR. RICHARD P. ANDERSON DDS. INC
Entity type:Organization
Organization Name:DR. RICHARD P. ANDERSON DDS. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:P
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:210-227-9921
Mailing Address - Street 1:1804 BUENA VISTA ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78207-3805
Mailing Address - Country:US
Mailing Address - Phone:210-227-9921
Mailing Address - Fax:210-223-4081
Practice Address - Street 1:1804 BUENA VISTA ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-3805
Practice Address - Country:US
Practice Address - Phone:210-227-9921
Practice Address - Fax:210-223-4081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-06
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX96491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty