Healthcare Provider Details

I. General information

NPI: 1699736603
Provider Name (Legal Business Name): LLOYD THEODORE ANDERSON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 BECKER AVE SW
WILLMAR MN
56201-3234
US

IV. Provider business mailing address

620 BECKER AVE SW
WILLMAR MN
56201-3234
US

V. Phone/Fax

Practice location:
  • Phone: 320-235-4622
  • Fax: 320-235-7083
Mailing address:
  • Phone: 320-235-4622
  • Fax: 320-235-7083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number9281
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: