MEDICARE: MR. SEAN M ANDERSON DDS

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
1	122300000X	Dentist	42519	CA

General Provider Information

NPI Number	:	1316954241
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SEAN M ANDERSON DDS

Provider Business Mailing Address
First Line	:	1501 BOLLINGER CANYON RD
Second Line	:	SUITE G
City	:	SAN RAMON
State	:	CA
Zip	:	94583-1758
Country	:	US
Telephone Number	:	925-837-4486
Fax Number	:	925-837-8164

Provider Business Practice Location Address
First Line	:	1501 BOLLINGER CANYON RD
Second Line	:	SUITE G
City	:	SAN RAMON
State	:	CA
Zip	:	94583-1758
Country	:	US
Telephone Number	:	925-837-4486
Fax Number	:	925-837-8164

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2006
Last Update Date	:	07/08/2007

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