Healthcare Provider Details

I. General information

NPI: 1376599373
Provider Name (Legal Business Name): CLIFFORD V ANDERSON DDS AND ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 02/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4240 BLUE RIDGE BLVD SUITE 800
KANSAS CITY MO
64133
US

IV. Provider business mailing address

4240 BLUE RIDGE BLVD SUITE 800
KANSAS CITY MO
64133-1713
US

V. Phone/Fax

Practice location:
  • Phone: 816-353-7200
  • Fax: 816-353-5162
Mailing address:
  • Phone: 816-353-7200
  • Fax: 816-353-5162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. CLIFFORD VIRGIL ANDERSON
Title or Position: PRESIDENT
Credential: DDS
Phone: 816-353-7200