=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023437472
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOAN I ANDERSON & CO
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/14/2014
-----------------------------------------------------
Last Update Date | 04/14/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1971 EVELYN BYRD AVE SUITE F
-----------------------------------------------------
City | HARRISONBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22801-3477
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-705-0102
-----------------------------------------------------
Fax | 540-246-0663
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1971 EVELYN BYRD AVE SUITE F
-----------------------------------------------------
City | HARRISONBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22801-3477
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-705-0102
-----------------------------------------------------
Fax | 540-246-0663
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PRESIDENT/DENTIST
-----------------------------------------------------
Name | DR. JOAN ISABELL ANDERSON
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 540-705-0102
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 124Q00000X
-----------------------------------------------------
Taxonomy Name | Dental Hygienist
-----------------------------------------------------
License Number | 0402206209
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 0401413162
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------