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General NPI Number Information
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NPI Number | 1083624621
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Entity Type | Individual
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Provider Name | DAVID CHARLES ANDERSON DDS
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Gender | Male
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Dates
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Enumeration Date | 08/08/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 430 MAIN ST
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City | GREEN BAY
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State | WI
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Zip | 54301-5115
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Country | US
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Telephone | 920-431-0345
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Fax |
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Provider Business Mailing Address
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Address Line | 5318 NORTH ROSEMARY LANE
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City | APPLETON
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State | WI
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Zip | 54913
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Country | US
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Telephone | 920-730-9027
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 5956
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License Number State | WI
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