Healthcare Provider Details

I. General information

NPI: 1033286786
Provider Name (Legal Business Name): CHER L ANDERSON RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4355 E UNIVERSITY DR #103
MESA AZ
85205-7000
US

IV. Provider business mailing address

PO BOX 981
QUEEN CREEK AZ
85242-0981
US

V. Phone/Fax

Practice location:
  • Phone: 480-830-0187
  • Fax:
Mailing address:
  • Phone: 480-388-1564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberH4550
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: