MEDICARE: DR. KARL D. ANDERSON D.D.S.

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	122300000X	Dentist	D1087	SD

General Provider Information

NPI Number	:	1699157628
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KARL D. ANDERSON D.D.S.

Provider Business Mailing Address
First Line	:	1219 SAINT JOSEPH ST
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57701-2669
Country	:	US
Telephone Number	:	605-721-1219
Fax Number	:

Provider Business Practice Location Address
First Line	:	1219 SAINT JOSEPH ST
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57701-2669
Country	:	US
Telephone Number	:	605-721-1219
Fax Number	:

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

Provider Enumeration Date	:	06/25/2015
Last Update Date	:	06/25/2015

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