Provider Demographics
NPI:1912928375
Name:ANDERSON, L. ERIC
Entity Type:Individual
Prefix:DR
First Name:L.
Middle Name:ERIC
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8232 CHAMBERY BLVD
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:IA
Mailing Address - Zip Code:50131-8773
Mailing Address - Country:US
Mailing Address - Phone:515-270-2270
Mailing Address - Fax:
Practice Address - Street 1:2501 WESTOWN PKWY
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-1438
Practice Address - Country:US
Practice Address - Phone:515-276-8572
Practice Address - Fax:515-334-7274
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA80041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA22249OtherWELLMARK BCBS