Organization
MISSISSIPPI VALLEY ORAL & MAXILLOFACIAL SURGERY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID A ANDERSON DDS (OWNER/DOCTOR)
(563) 355-9424
Entity
Organization
Contact information
Practice address
2305 E 52ND ST, SUITE 1, DAVENPORT, IA 52807-2762
(563) 355-9424
(563) 355-0180
Mailing address
2305 E 52ND ST, SUITE 1, DAVENPORT, IA 52807-2762
(563) 355-9424
(563) 355-0180
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
7637
IA
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
7766
IA
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
7839
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009776
—
IA
05
—
0123224
—
IA
05
—
0205898
—
IA
Enumeration date
03/10/2008
Last updated
03/11/2008
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