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General NPI Number Information
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NPI Number | 1467867580
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Entity Type | Organization
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Legal Business Name | DEVIN ANDERSON D,D.S.
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Dates
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Enumeration Date | 06/26/2014
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Last Update Date | 06/26/2014
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Provider Practice Location Address
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Address Line | 11261 WAREHAM CT
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City | LOMA LINDA
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State | CA
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Zip | 92354-4875
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Country | US
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Telephone | 909-496-1718
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Fax | 909-478-0778
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Provider Business Mailing Address
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Address Line | 11261 WAREHAM CT
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City | LOMA LINDA
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State | CA
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Zip | 92354-4875
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Country | US
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Telephone | 909-496-1718
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Fax | 909-478-0778
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Authorized Official
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Title or Position | DENTIST ANESTHESIOLOGIST
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Name | DR. DEVIN LEE ANDERSON
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Credential | D,D.S.
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Telephone | 909-496-1718
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 46353
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License Number State | CA
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