Healthcare Provider Details

I. General information

NPI: 1679543094
Provider Name (Legal Business Name): HOWARD HUGH ANDERSON JR. DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1647 TAUSSIG BLVD
NORFOLK VA
23511-2896
US

IV. Provider business mailing address

220 E 41ST ST
NORFOLK VA
23504-1014
US

V. Phone/Fax

Practice location:
  • Phone: 757-314-6500
  • Fax:
Mailing address:
  • Phone: 757-623-1366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number1960-82
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: