MEDICARE: MR. MICHAEL JOSEPH ANDERSON 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	5260	LA

General Provider Information

NPI Number	:	1477558369
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL JOSEPH ANDERSON DDS

Provider Business Mailing Address
First Line	:	610 NORTH RANGE AVENUE
Second Line	:
City	:	DENHAM SPRINGS
State	:	LA
Zip	:	70726-2900
Country	:	US
Telephone Number	:	225-665-1212
Fax Number	:	225-664-7404

Provider Business Practice Location Address
First Line	:	610 NORTH RANGE AVENUE
Second Line	:
City	:	DENHAM SPRINGS
State	:	LA
Zip	:	70726-2900
Country	:	US
Telephone Number	:	225-665-1212
Fax Number	:	225-664-7404

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

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	12/14/2012

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