Healthcare Provider Details

I. General information

NPI: 1760600035
Provider Name (Legal Business Name): DAWN M ANDERSON D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 03/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 E. GRASS VALLEY ST.
COLFAX CA
95713-1300
US

IV. Provider business mailing address

PO BOX 1300 33 E. GRASS VALLEY STREET
COLFAX CA
95713-1300
US

V. Phone/Fax

Practice location:
  • Phone: 530-346-2214
  • Fax:
Mailing address:
  • Phone: 530-346-2214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number54982
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: