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General NPI Number Information
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NPI Number | 1902959646
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Entity Type | Organization
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Legal Business Name | LA ANDERSON & ASSOCIATES PLLC
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Dates
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Enumeration Date | 01/18/2007
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Last Update Date | 10/29/2008
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Provider Practice Location Address
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Address Line | 411 E STATESVILLE AVE
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City | MOORESVILLE
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State | NC
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Zip | 28115-2533
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Country | US
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Telephone | 704-663-3300
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Fax | 704-663-0188
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Provider Business Mailing Address
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Address Line | 411 E STATESVILLE AVE
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City | MOORESVILLE
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State | NC
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Zip | 28115-2533
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Country | US
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Telephone | 704-663-3300
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Fax | 704-663-0188
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JIMMIE ANDERSON
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Credential | DDS
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Telephone | 704-663-3300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 6793
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License Number State | NC
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