Individual
ERIC W ANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
121 DELAWARE ST, LEAVENWORTH, KS 66048-2822
(913) 651-5040
(503) 494-8384
Mailing address
6120 SW 18TH DR APT 38, PORTLAND, OR 97239-1992
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
2019010204
MO
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
61280
KS
Other
Enumeration date
12/19/2006
Last updated
07/10/2019
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