=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124266788
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TOD CHRISTIAN ANDERSON D.D.S
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/04/2009
-----------------------------------------------------
Last Update Date | 11/20/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9520 SOQUEL DR
-----------------------------------------------------
City | APTOS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95003-4160
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 831-688-1006
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4145 PORTOLA DR. APT. #202
-----------------------------------------------------
City | SANTA CRUZ
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95062-4505
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 831-600-8081
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 56685
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------