Healthcare Provider Details

I. General information

NPI: 1760043202
Provider Name (Legal Business Name): CRAIG W ANDERSON DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2019
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 S CEDAR CREST BLVD STE 1
ALLENTOWN PA
18103-6242
US

IV. Provider business mailing address

1321 N NEW ST
BETHLEHEM PA
18018-2400
US

V. Phone/Fax

Practice location:
  • Phone: 612-624-8600
  • Fax:
Mailing address:
  • Phone: 610-861-7406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDS044511
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: