Healthcare Provider Details

I. General information

NPI: 1649372798
Provider Name (Legal Business Name): DONALD G ANDERSON DDS MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 11/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3105 E 98TH ST SUITE 130
INDIANAPOLIS IN
46280-2005
US

IV. Provider business mailing address

3105 E 98TH ST SUITE 130
INDIANAPOLIS IN
46280-2005
US

V. Phone/Fax

Practice location:
  • Phone: 317-569-9977
  • Fax: 317-569-9988
Mailing address:
  • Phone: 317-569-9977
  • Fax: 317-569-9988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number12009805
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: