MEDICARE: DR. MARK STEVEN ANDERSON

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	64983	CA

General Provider Information

NPI Number	:	1245606060
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK STEVEN ANDERSON

Provider Business Mailing Address
First Line	:	68905 VISTA CHINO
Second Line	:
City	:	CATHEDRAL CITY
State	:	CA
Zip	:	92234-4866
Country	:	US
Telephone Number	:	951-444-8805
Fax Number	:

Provider Business Practice Location Address
First Line	:	68905 VISTA CHINO
Second Line	:
City	:	CATHEDRAL CITY
State	:	CA
Zip	:	92234-4866
Country	:	US
Telephone Number	:	951-444-8805
Fax Number	:

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

Provider Enumeration Date	:	08/16/2015
Last Update Date	:	08/16/2015

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