Individual
DR. MACY RUTH ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S
Contact information
Practice address
5150 N PORT WASHINGTON RD STE 201, GLENDALE, WI 53217-5400
(414) 964-8850
Mailing address
5150 N PORT WASHINGTON RD STE 201, GLENDALE, WI 53217-5400
(414) 964-8850
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
1002304
WI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/22/2020
Last updated
08/16/2022
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