Healthcare Provider Details

I. General information

NPI: 1013941459
Provider Name (Legal Business Name): PAUL ANDERSON LINES D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2415 S RURAL RD SUITE B
TEMPE AZ
85282-2440
US

IV. Provider business mailing address

2415 S RURAL RD SUITE B
TEMPE AZ
85282-2440
US

V. Phone/Fax

Practice location:
  • Phone: 480-968-3848
  • Fax: 480-967-8669
Mailing address:
  • Phone: 480-968-3848
  • Fax: 480-967-8669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number1556
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number11703
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number950
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: