Healthcare Provider Details

I. General information

NPI: 1750413456
Provider Name (Legal Business Name): THOMAS T ANDERSON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 02/19/2021
Certification Date: 02/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

422 BROADWAY STREET
TOWNSEND MT
59644
US

IV. Provider business mailing address

344 ANNIE GLADE DRIVE 344 ANNIE GLADE DRIVE
BOZEMAN MT
59718
US

V. Phone/Fax

Practice location:
  • Phone: 406-266-3402
  • Fax:
Mailing address:
  • Phone: 208-589-2644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD1989
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: