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NPI Code Detail

MEDICARE: DR. ROBERT J ANDERSON DDS

MEDICARE: DR. ROBERT J 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
1122300000XDentist655IN

General Provider Information

NPI Number : 1619173606
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ROBERT J ANDERSON DDS
Provider Business Mailing Address
First Line : 2001 BLAKE AVE
Second Line : SUITE 2D
City : GLENWOOD SPRINGS
State : CO
Zip : 81601-4282
Country : US
Telephone Number : 970-945-9807
Fax Number : 970-945-9746
Provider Business Practice Location Address
First Line : 2001 BLAKE AVENUE
Second Line : SUITE 2D
City : GLENWOOD SPRINGS
State : CO
Zip : 81601-4282
Country : US
Telephone Number : 970-945-9807
Fax Number : 970-945-9746
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/26/2007
Last Update Date : 07/08/2007

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