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General NPI Number Information
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NPI Number | 1144490707
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Entity Type | Organization
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Legal Business Name | MISSISSIPPI VALLEY ORAL & MAXILLOFACIAL SURGERY PC
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Dates
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Enumeration Date | 03/10/2008
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Last Update Date | 03/11/2008
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Provider Practice Location Address
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Address Line | 2305 E 52ND ST SUITE 1
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City | DAVENPORT
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State | IA
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Zip | 52807-2762
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Country | US
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Telephone | 563-355-9424
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Fax | 563-355-0180
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Provider Business Mailing Address
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Address Line | 2305 E 52ND ST SUITE 1
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City | DAVENPORT
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State | IA
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Zip | 52807-2762
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Country | US
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Telephone | 563-355-9424
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Fax | 563-355-0180
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Authorized Official
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Title or Position | OWNER/DOCTOR
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Name | DR. DAVID A ANDERSON
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Credential | DDS
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Telephone | 563-355-9424
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 7637
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 7766
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License Number State | IA
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Taxonomy #3
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 7839
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License Number State | IA
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