Healthcare Provider Details

I. General information

NPI: 1114493582
Provider Name (Legal Business Name): MATT W ANDERSON DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2018
Last Update Date: 10/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2215 WILLAMETTE ST STE A
EUGENE OR
97405-3341
US

IV. Provider business mailing address

2215 WILLAMETTE ST STE A
EUGENE OR
97405-3341
US

V. Phone/Fax

Practice location:
  • Phone: 541-345-4076
  • Fax:
Mailing address:
  • Phone: 541-345-4076
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. MATT W ANDERSON
Title or Position: OWNER
Credential: DDS
Phone: 541-345-4076