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General NPI Number Information
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NPI Number | 1174687925
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Entity Type | Individual
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Provider Name | ERIC W ANDERSON DMD
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Gender | Male
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Dates
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Enumeration Date | 12/19/2006
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Last Update Date | 07/10/2019
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Provider Practice Location Address
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Address Line | 121 DELAWARE ST
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City | LEAVENWORTH
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State | KS
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Zip | 66048-2822
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Country | US
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Telephone | 913-651-5040
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Fax | 503-494-8384
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Provider Business Mailing Address
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Address Line | 6120 SW 18TH DR APT 38
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City | PORTLAND
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State | OR
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Zip | 97239-1992
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Country | US
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Telephone |
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 2019010204
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 61280
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License Number State | KS
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