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NPI Code Detail

MEDICARE: ROGER ANDERSON DDS

MEDICARE: ROGER 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
1122300000XDentist21969CA

General Provider Information

NPI Number : 1669652350
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROGER ANDERSON DDS
Provider Business Mailing Address
First Line : 5100 OBYRNES FERRY RD
Second Line :
City : JAMESTOWN
State : CA
Zip : 95327-9102
Country : US
Telephone Number : 209-984-5291
Fax Number : 209-984-0151
Provider Business Practice Location Address
First Line : 5100 OBYRNES FERRY RD
Second Line :
City : JAMESTOWN
State : CA
Zip : 95327-9102
Country : US
Telephone Number : 209-984-5291
Fax Number : 209-984-0151
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/09/2007
Last Update Date : 11/09/2007

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Directions to “ ROGER ANDERSON DDS” Practice Location

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