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General NPI Number Information
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NPI Number | 1740809938
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Entity Type | Organization
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Legal Business Name | J. ANDERSON DDS, INC
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Dates
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Enumeration Date | 04/09/2020
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Last Update Date | 04/09/2020
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Provider Practice Location Address
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Address Line | 1235 W VISTA WAY STE K
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City | VISTA
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State | CA
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Zip | 92083-6234
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Country | US
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Telephone | 661-474-0880
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Fax |
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Provider Business Mailing Address
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Address Line | 4809 WINDJAMMER WAY
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City | CARLSBAD
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State | CA
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Zip | 92008-3789
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Country | US
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Telephone | 661-474-0880
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JEFFREY MICHAEL ANDERSON
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Credential | DDS
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Telephone | 661-474-0880
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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 |
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License Number State |
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