MEDICARE: JAMES DAVID ANDERSON DMD

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	11975	GA

General Provider Information

NPI Number	:	1467552935
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES DAVID ANDERSON DMD

Provider Business Mailing Address
First Line	:	2663 SANDY PLAINS ROAD
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30066
Country	:	US
Telephone Number	:	770-977-0827
Fax Number	:	770-973-6764

Provider Business Practice Location Address
First Line	:	2663 SANDY PLAINS ROAD
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30066
Country	:	US
Telephone Number	:	770-977-0827
Fax Number	:	770-973-6764

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

Provider Enumeration Date	:	09/25/2006
Last Update Date	:	07/08/2007

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