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NPI Code Detail

MEDICARE: DR. ROSS ALLEN ANDERSON D.D.S.

MEDICARE: DR. ROSS ALLEN 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
11223G0001XGeneral Practice DentistryD12791MN
2282N00000XGeneral Acute Care HospitalD12791MN

General Provider Information

NPI Number : 1891011748
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ROSS ALLEN ANDERSON D.D.S.
Provider Business Mailing Address
First Line : 1225 E 1ST ST
Second Line :
City : DULUTH
State : MN
Zip : 55805-2402
Country : US
Telephone Number : 218-728-6445
Fax Number :
Provider Business Practice Location Address
First Line : 1225 E 1ST ST
Second Line :
City : DULUTH
State : MN
Zip : 55805-2402
Country : US
Telephone Number : 218-728-6445
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/18/2010
Last Update Date : 04/27/2012

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