MEDICARE: ANDERSON DENTAL ASSOCIATES II PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	0401412572	VA

General Provider Information

NPI Number	:	1013368398
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANDERSON DENTAL ASSOCIATES II PLLC

Provider Business Mailing Address
First Line	:	14007 MINNIEVILLE RD
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22193-2310
Country	:	US
Telephone Number	:	703-670-5414
Fax Number	:	703-670-4545

Provider Business Practice Location Address
First Line	:	14007 MINNIEVILLE RD
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22193-2310
Country	:	US
Telephone Number	:	703-670-5414
Fax Number	:	703-670-4545

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JOSHUA W ANDERSON
Credential	:	DDS
Telephone Number	:	703-670-5414

Provider Enumeration Date	:	06/28/2016
Last Update Date	:	06/28/2016

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