MEDICARE: DR. ROBERT LEE 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	07369	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	03761	OTHER	IA	PROVIDER NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790837391
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT LEE ANDERSON DDS

Provider Business Mailing Address
First Line	:	7654 HICKMAN RD
Second Line	:
City	:	WINDSOR HEIGHTS
State	:	IA
Zip	:	50322-4510
Country	:	US
Telephone Number	:	515-276-9330
Fax Number	:	515-276-0396

Provider Business Practice Location Address
First Line	:	7654 HICKMAN RD
Second Line	:
City	:	WINDSOR HEIGHTS
State	:	IA
Zip	:	50322-4510
Country	:	US
Telephone Number	:	515-276-9330
Fax Number	:	515-276-0396

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

Provider Enumeration Date	:	01/17/2007
Last Update Date	:	07/09/2007

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