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General NPI Number Information
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NPI Number | 1467729020
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Entity Type | Organization
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Legal Business Name | CHARLES C. ANDERSON D.D.S. S.C.
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Dates
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Enumeration Date | 11/28/2011
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Last Update Date | 11/28/2011
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Provider Practice Location Address
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Address Line | 7218 S. 76TH STREET
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City | FRANKLIN
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State | WI
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Zip | 53132-9041
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Country | US
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Telephone | 414-425-2900
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Fax | 414-425-2901
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Provider Business Mailing Address
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Address Line | 7218 S. 76TH STREET
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City | FRANKLIN
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State | WI
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Zip | 53132-9041
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Country | US
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Telephone | 414-425-2900
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Fax | 414-425-2901
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Authorized Official
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Title or Position | PRESIDENT / OWNER
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Name | DR. CHARLES C. ANDERSON
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Credential | D.D.S.
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Telephone | 414-425-2900
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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 |
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License Number State | WI
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