Healthcare Provider Details

I. General information

NPI: 1205002110
Provider Name (Legal Business Name): SCOTT D ANDERSON DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2008
Last Update Date: 10/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 N MAIN ST
GUNNISON CO
81230-2404
US

IV. Provider business mailing address

306 N MAIN ST
GUNNISON CO
81230-2404
US

V. Phone/Fax

Practice location:
  • Phone: 970-641-4200
  • Fax: 970-641-3262
Mailing address:
  • Phone: 970-641-4200
  • Fax: 970-641-3262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number8296
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number8296
License Number StateCO

VIII. Authorized Official

Name: JENNIFER R FLYNN
Title or Position: PRACTICE MGR
Credential:
Phone: 970-641-4200