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General NPI Number Information
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NPI Number | 1063796456
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Entity Type | Organization
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Legal Business Name | BRIAN E. ANDERSON, D.D.S., PLLC
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Dates
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Enumeration Date | 10/04/2011
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Last Update Date | 10/04/2011
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Provider Practice Location Address
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Address Line | 125 N. PANSY ST
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City | ISHPEMING
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State | MI
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Zip | 49849
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Country | US
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Telephone | 906-485-5575
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Fax | 906-485-1260
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Provider Business Mailing Address
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Address Line | 125 N. PANSY ST
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City | ISHPEMING
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State | MI
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Zip | 49849
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Country | US
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Telephone | 906-485-5575
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Fax | 906-485-1260
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | DR. BRIAN EDWARD ANDERSON
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Credential | D.D.S.
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Telephone | 906-485-5575
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 2901019979
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License Number State | MI
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