Healthcare Provider Details

I. General information

NPI: 1396919106
Provider Name (Legal Business Name): STEWART JOSEPH ANDERSON D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2008
Last Update Date: 03/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4520 LOWER TERRACE CIR NE
ALBUQUERQUE NM
87111-2503
US

IV. Provider business mailing address

4520 LOWER TERRACE CIR NE
ALBUQUERQUE NM
87111-2503
US

V. Phone/Fax

Practice location:
  • Phone: 505-299-4431
  • Fax: 505-291-0265
Mailing address:
  • Phone: 505-299-4431
  • Fax: 505-291-0265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDD3103
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License NumberDD3103
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: