Healthcare Provider Details

I. General information

NPI: 1497594188
Provider Name (Legal Business Name): BRIANNA MARIE ANDERSON DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2024
Last Update Date: 05/22/2024
Certification Date: 05/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40470 GERMANY RD
GONZALES LA
70737-6735
US

IV. Provider business mailing address

158 E OAKLAND ST
SAINT ROSE LA
70087-3230
US

V. Phone/Fax

Practice location:
  • Phone: 225-622-2022
  • Fax:
Mailing address:
  • Phone: 504-644-0060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7521
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: