MEDICARE: DR. ROSS WILLIAM 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
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	2901013714	MI

General Provider Information

NPI Number	:	1891971081
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROSS WILLIAM ANDERSON D.D.S.

Provider Business Mailing Address
First Line	:	8510 N CANTON CENTER RD
Second Line	:
City	:	CANTON
State	:	MI
Zip	:	48187-1310
Country	:	US
Telephone Number	:	734-459-4430
Fax Number	:	734-459-5954

Provider Business Practice Location Address
First Line	:	8510 N CANTON CENTER RD
Second Line	:
City	:	CANTON
State	:	MI
Zip	:	48187-1310
Country	:	US
Telephone Number	:	734-459-4430
Fax Number	:	734-459-5954

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

Provider Enumeration Date	:	01/17/2008
Last Update Date	:	01/17/2008

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