Healthcare Provider Details

I. General information

NPI: 1467610725
Provider Name (Legal Business Name): SCOTT T. ANDERSON, DDS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2008
Last Update Date: 05/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S RIVERVIEW ST
BELLEVUE IA
52031-1350
US

IV. Provider business mailing address

400 S RIVERVIEW ST
BELLEVUE IA
52031-1350
US

V. Phone/Fax

Practice location:
  • Phone: 563-872-3211
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number7390
License Number StateIA

VIII. Authorized Official

Name: DR. SCOTT THOMAS ANDERSON
Title or Position: DENTIST/OWNER
Credential:
Phone: 563-872-3211