Healthcare Provider Details

I. General information

NPI: 1831106004
Provider Name (Legal Business Name): JOHN A. ANDERSON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 N CENTER ST
AMERICAN FORK UT
84003-1647
US

IV. Provider business mailing address

11534 N 6180 W
HIGHLAND UT
84003-3751
US

V. Phone/Fax

Practice location:
  • Phone: 801-756-2341
  • Fax:
Mailing address:
  • Phone: 801-492-0592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number911453419922
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: