Healthcare Provider Details

I. General information

NPI: 1770897910
Provider Name (Legal Business Name): SCOTT MITCHELL ANDERSON D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2010
Last Update Date: 08/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 A AVE NE STE LL1
CEDAR RAPIDS IA
52402-5064
US

IV. Provider business mailing address

855 A AVE NE STE LL1
CEDAR RAPIDS IA
52402-5064
US

V. Phone/Fax

Practice location:
  • Phone: 319-369-7730
  • Fax: 319-369-7192
Mailing address:
  • Phone: 319-369-7730
  • Fax: 319-369-7192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number08748
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: