Provider Demographics
NPI:1669592598
Name:ANDERSON, MARC L (DDS)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:L
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9940 BELVEDERE RD
Mailing Address - Street 2:STE E
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411
Mailing Address - Country:US
Mailing Address - Phone:561-333-4457
Mailing Address - Fax:561-333-1521
Practice Address - Street 1:9940 BELVEDERE RD
Practice Address - Street 2:STE E
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411
Practice Address - Country:US
Practice Address - Phone:561-333-4457
Practice Address - Fax:561-333-1521
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN168981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice