Healthcare Provider Details

I. General information

NPI: 1770669541
Provider Name (Legal Business Name): RALPH H.B. ANDERSON DR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 12/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 MONUMENT AVE SUITE K
RICHMOND VA
23226-1452
US

IV. Provider business mailing address

5500 MONUMENT AVE SUITE K
RICHMOND VA
23226-1452
US

V. Phone/Fax

Practice location:
  • Phone: 804-285-9800
  • Fax: 804-285-5711
Mailing address:
  • Phone: 804-285-9800
  • Fax: 804-285-5711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number0401008749
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: