MEDICARE: DR. RICHARD P ANDERSON D.D.S.

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	122300000X	Dentist	9649	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033254859
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD P ANDERSON D.D.S.

Provider Business Mailing Address
First Line	:	1804 BUENA VISTA ST
Second Line	:	COR. BUENA VISTA AND TRINITY
City	:	SAN ANTONIO
State	:	TX
Zip	:	78207-3805
Country	:	US
Telephone Number	:	210-227-9921
Fax Number	:	210-223-4081

Provider Business Practice Location Address
First Line	:	1804 BUENA VISTA ST
Second Line	:	COR. BUENA VISTA AND TRINITY
City	:	SAN ANTONIO
State	:	TX
Zip	:	78207-3805
Country	:	US
Telephone Number	:	210-227-9921
Fax Number	:	210-223-4081

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/20/2007
Last Update Date	:	07/09/2007

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