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General NPI Number Information
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NPI Number | 1881087518
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Entity Type | Individual
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Provider Name | BRIAN CRAIG ANDERSON D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 03/04/2015
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Last Update Date | 03/04/2015
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Provider Practice Location Address
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Address Line | 1830 PROSPECTOR AVE
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City | PARK CITY
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State | UT
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Zip | 84060-7319
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Country | US
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Telephone | 435-649-6959
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Fax |
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Provider Business Mailing Address
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Address Line | 2420 E WRENHAVEN LN
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City | SALT LAKE CITY
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State | UT
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Zip | 84121-2365
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Country | US
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Telephone | 801-891-5580
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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 | 8715278-9921
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License Number State | UT
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