MEDICARE: TRENT M. ANDERSON, D.D.S., P.L.L.C.

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	D11423	MN

General Provider Information

NPI Number	:	1265606248
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRENT M. ANDERSON, D.D.S., P.L.L.C.

Provider Business Mailing Address
First Line	:	1871 OLD HUDSON RD
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55119-4308
Country	:	US
Telephone Number	:	651-738-0900
Fax Number	:

Provider Business Practice Location Address
First Line	:	1871 OLD HUDSON RD
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55119-4308
Country	:	US
Telephone Number	:	651-738-0900
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	DR. TRENT MITCHEL ANDERSON
Credential	:	D.D.S.
Telephone Number	:	651-353-6651

Provider Enumeration Date	:	04/21/2008
Last Update Date	:	04/21/2008

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