Provider Demographics
NPI:1801051180
Name:ANDERSON DENTAL, P.C.
Entity type:Organization
Organization Name:ANDERSON DENTAL, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:406-642-3771
Mailing Address - Street 1:2412 MERIDIAN RD.
Mailing Address - Street 2:P.O. BOX 27
Mailing Address - City:VICTOR
Mailing Address - State:MT
Mailing Address - Zip Code:59875
Mailing Address - Country:US
Mailing Address - Phone:406-642-3771
Mailing Address - Fax:406-642-3646
Practice Address - Street 1:2412 MERIDIAN RD.
Practice Address - Street 2:
Practice Address - City:VICTOR
Practice Address - State:MT
Practice Address - Zip Code:59875
Practice Address - Country:US
Practice Address - Phone:406-642-3771
Practice Address - Fax:406-642-3646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-25
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT23071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty