Healthcare Provider Details

I. General information

NPI: 1073583100
Provider Name (Legal Business Name): ALFRED CHRISTIAN ANDERSON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DEPT OF THE ARMY, DENTAL ACTIVITY, STOP B 2817 REILLY RD, MCDS-NA-B
FORT BRAGG NC
28310-0001
US

IV. Provider business mailing address

DEPT OF THE ARMY, DENTAL ACTIVITY, STOP B 2817 REILLY RD, MCDS-NA-B
FORT BRAGG NC
28310-0001
US

V. Phone/Fax

Practice location:
  • Phone: 910-396-5610
  • Fax: 910-396-7017
Mailing address:
  • Phone: 910-396-5610
  • Fax: 910-396-7017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number4827090-9926
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number4827090-9922
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: