Individual
THEODORE MICHAEL ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
3637 WILGUS AVENUE, SHEBOYGAN, WI 53081
(920) 458-8213
(920) 459-9797
Mailing address
3637 WILGUS AVENUE, SHEBOYGAN, WI 53081
(920) 458-8213
(920) 459-9797
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
4516015
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33741300
—
WI
Enumeration date
05/08/2006
Last updated
01/06/2009
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