Healthcare Provider Details

I. General information

NPI: 1679352009
Provider Name (Legal Business Name): LORI K ANDERSON DDS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2023
Last Update Date: 09/25/2023
Certification Date: 09/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 W CAREFREE HWY STE 108
PHOENIX AZ
85085-6095
US

IV. Provider business mailing address

2525 W CAREFREE HWY STE 108
PHOENIX AZ
85085-6095
US

V. Phone/Fax

Practice location:
  • Phone: 623-455-9179
  • Fax:
Mailing address:
  • Phone: 623-455-9179
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LORI K ANDERSON
Title or Position: DOCTOR
Credential: DDS
Phone: 623-455-9179