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General NPI Number Information
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NPI Number | 1659668762
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Entity Type | Individual
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Provider Name | KATHLEEN E ANDERSON D.M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/10/2011
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Last Update Date | 11/26/2014
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Provider Practice Location Address
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Address Line | 950 LAKE BALDWIN LN
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City | ORLANDO
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State | FL
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Zip | 32814-6651
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Country | US
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Telephone | 407-515-8500
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Fax |
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Provider Business Mailing Address
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Address Line | 1206 BURNING TREE LN
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City | WINTER PARK
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State | FL
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Zip | 32792-5123
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Country | US
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Telephone | 352-339-0959
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DN 19371
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License Number State | FL
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