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General NPI Number Information
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NPI Number | 1093171977
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Entity Type | Organization
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Legal Business Name | GREG A. ANDERSON, DDS,PC
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Dates
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Enumeration Date | 01/08/2016
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Last Update Date | 01/08/2016
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Provider Practice Location Address
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Address Line | 501 MAIN ST SUITE 4
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City | WILLISTON
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State | ND
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Zip | 58801-5327
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Country | US
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Telephone | 701-577-2261
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Fax | 701-577-0737
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Provider Business Mailing Address
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Address Line | PO BOX 1127
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City | WILLISTON
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State | ND
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Zip | 58802-1127
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Country | US
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Telephone | 701-577-2261
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Fax | 701-577-0737
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Authorized Official
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Title or Position | PRESIDENT
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Name | GREGORY A. ANDERSON
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Credential | DDS
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Telephone | 701-577-2261
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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 |
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License Number State |
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