Provider Demographics
NPI:1831247196
Name:ANDERSON, JEFFREY LORIN (DDS)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:LORIN
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4555 ERIN DR STE 100
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-3334
Mailing Address - Country:US
Mailing Address - Phone:651-452-2496
Mailing Address - Fax:
Practice Address - Street 1:4555 ERIN DR STE 100
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-3334
Practice Address - Country:US
Practice Address - Phone:651-452-2496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNMN D9275122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist