=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487436531
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THOMAS L ANDERSON, DDS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/13/2023
-----------------------------------------------------
Last Update Date | 10/13/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4911 S ARROWHEAD DR STE 300
-----------------------------------------------------
City | INDEPENDENCE
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64055-7018
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-373-4440
-----------------------------------------------------
Fax | 816-795-6732
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4911 S ARROWHEAD DR STE 300
-----------------------------------------------------
City | INDEPENDENCE
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64055-7018
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-373-4440
-----------------------------------------------------
Fax | 816-795-6732
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRACTICE MANAGER
-----------------------------------------------------
Name | DANA MOLTHAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 816-520-8666
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------