Healthcare Provider Details

I. General information

NPI: 1417906249
Provider Name (Legal Business Name): DAVID LEE ANDERSON D.D.S., M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 12/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2081 W RIDGE RD SUITE 101
ROCHESTER NY
14626-2724
US

IV. Provider business mailing address

2081 WEST RIDGE ROAD SUITE 105
ROCHESTER NY
14626-2724
US

V. Phone/Fax

Practice location:
  • Phone: 585-227-0800
  • Fax: 585-227-0802
Mailing address:
  • Phone: 585-227-0800
  • Fax: 585-227-0802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number046225
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: