# RYAN T ANDERSON DDC PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1952774465
- **Authorized official:** RYAN ANDERSON D.D.S (GENERAL DENTIST)
- **Authorized official phone:** (719) 384-9442

## Contact information

- **Practice address:** 13 E 4TH ST., LA JUNTA, CO 81050
- **Practice address phone:** (719) 384-9442
- **Mailing address:** 13 E 4TH ST, LA JUNTA, CO 81050-3601
- **Mailing address phone:** (719) 384-9442

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | 00202659 | CO | Yes |

## Other

- **Enumeration date:** 11/05/2015
- **Last updated:** 02/15/2019