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General NPI Number Information
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NPI Number | 1609481928
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Entity Type | Individual
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Provider Name | MYKEL ANDERSON DMD, MPH, MBA
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Gender | Female
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Dates
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Enumeration Date | 09/14/2020
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Last Update Date | 09/14/2020
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Provider Practice Location Address
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Address Line | 256 E LAKE MEAD PKWY
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City | HENDERSON
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State | NV
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Zip | 89015-6440
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Country | US
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Telephone | 702-703-5410
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Fax |
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Provider Business Mailing Address
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Address Line | 1350 KELSO DUNES AVE APT 315
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City | HENDERSON
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State | NV
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Zip | 89014-7826
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Country | US
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Telephone | 951-313-2129
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DDS104743
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 6978
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License Number State | NV
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