Provider Demographics
NPI:1982155529
Name:ANDERSON FAMILY DENTISTRY
Entity Type:Organization
Organization Name:ANDERSON FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TYSON
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-332-2116
Mailing Address - Street 1:13841 HULL STREET RD STE 5
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-2056
Mailing Address - Country:US
Mailing Address - Phone:804-744-1280
Mailing Address - Fax:804-744-2564
Practice Address - Street 1:13841 HULL STREET RD STE 5
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-2056
Practice Address - Country:US
Practice Address - Phone:804-744-1280
Practice Address - Fax:804-744-2564
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRAL VIRGINIA DENTAL CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-19
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty