Healthcare Provider Details

I. General information

NPI: 1174869978
Provider Name (Legal Business Name): MARK ANDERSON, DDS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2012
Last Update Date: 12/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6011 W PIERSON RD
FLUSHING MI
48433-2334
US

IV. Provider business mailing address

6011 W PIERSON RD
FLUSHING MI
48433-2334
US

V. Phone/Fax

Practice location:
  • Phone: 810-733-5566
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: LISA ANDERSON-CARPENTIER
Title or Position: DENTIST
Credential:
Phone: 810-733-5566