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General NPI Number Information
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NPI Number | 1518158641
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Entity Type | Organization
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Legal Business Name | DR. STANLEY J. ANDERSON, PC
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Dates
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Enumeration Date | 08/05/2007
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Last Update Date | 08/05/2007
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Provider Practice Location Address
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Address Line | 1211 GEORGE C WILSON DRIVE
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City | AUGUSTA
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State | GA
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Zip | 30909
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Country | US
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Telephone | 706-868-0183
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Fax | 706-868-8413
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Provider Business Mailing Address
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Address Line | 1211 GEORGE C. WILSON DRIVE
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City | AUGUSTA
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State | GA
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Zip | 30909
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Country | US
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Telephone | 706-868-0183
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Fax | 706-868-8413
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Authorized Official
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Title or Position | OWNER
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Name | DR. STANLEY J ANDERSON
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Credential | DMD
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Telephone | 706-868-0183
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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 | 8250
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License Number State | GA
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