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NPI Code Detail

MEDICARE: DR. ALAN H. ANDERSON D.D.S.

MEDICARE: DR. ALAN H. ANDERSON D.D.S.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist142218UT

General Provider Information

NPI Number : 1174746697
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ALAN H. ANDERSON D.D.S.
Provider Business Mailing Address
First Line : 7931 SHAGGY MOUNTAIN RD
Second Line :
City : HERRIMAN
State : UT
Zip : 84065-3676
Country : US
Telephone Number : 801-446-7047
Fax Number :
Provider Business Practice Location Address
First Line : 1758 W 4805 S
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84118-1177
Country : US
Telephone Number : 801-964-6699
Fax Number : 801-964-1347
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/11/2007
Last Update Date : 07/08/2007

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