Healthcare Provider Details

I. General information

NPI: 1356260178
Provider Name (Legal Business Name): JOHN RICHARD ANDERSEN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 N ST STE 301
ANCHORAGE AK
99501-3276
US

IV. Provider business mailing address

2100 COLONY LOOP
ANCHORAGE AK
99507-4400
US

V. Phone/Fax

Practice location:
  • Phone: 907-276-7787
  • Fax:
Mailing address:
  • Phone: 801-580-2821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number256420
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: