=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043436090
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR KIRK J ANDERTON DDS MS PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/18/2007
-----------------------------------------------------
Last Update Date | 07/26/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 803 W ELLIOT RD
-----------------------------------------------------
City | CHANDLER
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85225-1885
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-963-1355
-----------------------------------------------------
Fax | 480-963-1459
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 803 W ELLIOT RD
-----------------------------------------------------
City | CHANDLER
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85225-1885
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-963-1355
-----------------------------------------------------
Fax | 480-963-1459
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. BRYAN L GARNER
-----------------------------------------------------
Credential | DDS MS PC
-----------------------------------------------------
Telephone | 480-963-1355
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number | 4103
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------