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General NPI Number Information
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NPI Number | 1831884436
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Entity Type | Individual
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Provider Name | MIRANDA LYNN ANDERSON DDS
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Gender | Female
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Dates
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Enumeration Date | 04/10/2023
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Last Update Date | 11/27/2024
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Provider Practice Location Address
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Address Line | 516 N EVERGREEN RD
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City | SPOKANE VALLEY
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State | WA
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Zip | 99216-0852
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Country | US
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Telephone | 509-928-2525
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Fax |
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Provider Business Mailing Address
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Address Line | 2004 W DOMAINE CT
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City | COEUR D ALENE
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State | ID
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Zip | 83815-1001
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Country | US
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Telephone | 208-818-2820
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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 | D-5521
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DE61604888
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License Number State | WA
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