Provider Demographics
NPI:1881087518
Name:ANDERSON, BRIAN CRAIG (DDS)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:CRAIG
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 1:2420 E WRENHAVEN LN
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-2365
Mailing Address - Country:US
Mailing Address - Phone:801-891-5580
Mailing Address - Fax:
Practice Address - Street 1:1830 PROSPECTOR AVE
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84060-7319
Practice Address - Country:US
Practice Address - Phone:435-649-6959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-04
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8715278-99211223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics