Provider Demographics
NPI:1740492339
Name:ANDERSON, JEFFREY WILLIAM (DMD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:WILLIAM
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 5TH ST
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-4703
Mailing Address - Country:US
Mailing Address - Phone:203-356-9295
Mailing Address - Fax:203-921-1657
Practice Address - Street 1:50 GLENBROOK RD
Practice Address - Street 2:SUITE #1D
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-2969
Practice Address - Country:US
Practice Address - Phone:203-324-7333
Practice Address - Fax:203-921-1657
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT007739122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist