MEDICARE: DR. PHILIP NELS ANDERSEN DDS

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	6801	IA

General Provider Information

NPI Number	:	1073693636
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHILIP NELS ANDERSEN DDS

Provider Business Mailing Address
First Line	:	907 BANK CT
Second Line	:
City	:	CENTER POINT
State	:	IA
Zip	:	52213-9337
Country	:	US
Telephone Number	:	319-849-1171
Fax Number	:	319-849-2453

Provider Business Practice Location Address
First Line	:	907 BANK CT
Second Line	:
City	:	CENTER POINT
State	:	IA
Zip	:	52213-9337
Country	:	US
Telephone Number	:	319-849-1171
Fax Number	:	319-849-2453

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

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	01/25/2011

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