Healthcare Provider Details

I. General information

NPI: 1023437472
Provider Name (Legal Business Name): JOAN I ANDERSON & CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2014
Last Update Date: 04/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1971 EVELYN BYRD AVE SUITE F
HARRISONBURG VA
22801-3477
US

IV. Provider business mailing address

1971 EVELYN BYRD AVE SUITE F
HARRISONBURG VA
22801-3477
US

V. Phone/Fax

Practice location:
  • Phone: 540-705-0102
  • Fax: 540-246-0663
Mailing address:
  • Phone: 540-705-0102
  • Fax: 540-246-0663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0401413162
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number0402206209
License Number StateVA

VIII. Authorized Official

Name: DR. JOAN ISABELL ANDERSON
Title or Position: OWNER/PRESIDENT/DENTIST
Credential: DDS
Phone: 540-705-0102