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General NPI Number Information
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NPI Number | 1366831547
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Entity Type | Organization
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Legal Business Name | ANDERSON DENTAL ASSOCIATES PC
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Dates
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Enumeration Date | 01/12/2015
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Last Update Date | 01/12/2015
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Provider Practice Location Address
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Address Line | 315 W MARKET ST
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City | POTTSVILLE
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State | PA
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Zip | 17901-4066
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Country | US
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Telephone | 570-795-9560
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Fax | 570-516-9145
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Provider Business Mailing Address
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Address Line | 112 E PROVIDENCE RD
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City | ALDAN
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State | PA
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Zip | 19018-4127
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Country | US
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Telephone | 570-795-9560
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Fax | 570-516-9145
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JANET ANDERSON
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Credential | DMD
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Telephone | 570-795-9560
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DS026658L
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License Number State | PA
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