Healthcare Provider Details

I. General information

NPI: 1316321177
Provider Name (Legal Business Name): MICHAEL WARREN REGAN ANDERSON DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MICHAEL WARREN ANDERSON DDS, MS

II. Dates (important events)

Enumeration Date: 07/11/2015
Last Update Date: 08/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2659 SUPERIOR DR NW
ROCHESTER MN
55901-8533
US

IV. Provider business mailing address

2659 SUPERIOR DRIVE NW
ROCHESTER MN
55901
US

V. Phone/Fax

Practice location:
  • Phone: 507-281-1295
  • Fax:
Mailing address:
  • Phone: 507-281-1295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberD13552
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD13552
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: