Provider Demographics
NPI:1720743750
Name:ANDERSON, JAMES LUCAS (DD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:LUCAS
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:DD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:613 SAMISH SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98229-7882
Mailing Address - Country:US
Mailing Address - Phone:360-318-6811
Mailing Address - Fax:
Practice Address - Street 1:613 SAMISH SPRINGS DR
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98229-7882
Practice Address - Country:US
Practice Address - Phone:360-318-6811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-04
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADN60453955122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist