MEDICARE: DR. BRIAN MICHAEL ANDERSEN 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
1	1223G0001X	General Practice Dentistry	6295	WI
2	1223G0001X	General Practice Dentistry	08759	IA

General Provider Information

NPI Number	:	1740439843
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN MICHAEL ANDERSEN D.D.S.

Provider Business Mailing Address
First Line	:	3217 CEDAR HEIGHTS DR
Second Line	:
City	:	CEDAR FALLS
State	:	IA
Zip	:	50613-6039
Country	:	US
Telephone Number	:	319-277-6921
Fax Number	:

Provider Business Practice Location Address
First Line	:	3217 CEDAR HEIGHTS DR
Second Line	:
City	:	CEDAR FALLS
State	:	IA
Zip	:	50613-6039
Country	:	US
Telephone Number	:	319-277-6921
Fax Number	:

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

Provider Enumeration Date	:	09/12/2008
Last Update Date	:	08/03/2010

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