Provider Demographics
NPI:1881913010
Name:ANDERSON, RALPH LEMUS (DDS)
Entity type:Individual
Prefix:DR
First Name:RALPH
Middle Name:LEMUS
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 1:5500 MONUMENT AVE
Mailing Address - Street 2:SUITE R
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-1452
Mailing Address - Country:US
Mailing Address - Phone:804-285-9800
Mailing Address - Fax:804-258-5711
Practice Address - Street 1:5500 MONUMENT AVE
Practice Address - Street 2:SUITE R
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-1452
Practice Address - Country:US
Practice Address - Phone:804-285-9800
Practice Address - Fax:804-258-5711
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-27
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010039191223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0007617OtherDORAL DENTAL DENTAQUEST
VA003870OtherANTHEM HEALTHKEEPERS PLUS
VAVA007913702Medicaid
VA799259OtherUNITED CONCORDIA