MEDICARE: ALEXIS LEE ANDERSON RDH, BSDH

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	124Q00000X	Dental Hygienist	H10364	MN
2	124Q00000X	Dental Hygienist	RDH33066	CA

General Provider Information

NPI Number	:	1982326849
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXIS LEE ANDERSON RDH, BSDH

Provider Business Mailing Address
First Line	:	7655 SAN MIGUEL AVE
Second Line	:
City	:	LEMON GROVE
State	:	CA
Zip	:	91945-2814
Country	:	US
Telephone Number	:	952-200-2021
Fax Number	:

Provider Business Practice Location Address
First Line	:	NAB DENTAL AND MEDICAL CLINIC 3538 BOUGAINVILLE RD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92155-0001
Country	:	US
Telephone Number	:	559-805-1334
Fax Number	:

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

Provider Enumeration Date	:	09/16/2022
Last Update Date	:	09/16/2022

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