Individual
JOHN S ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
819 BLOOMINGTON RD, CHAMPAIGN, IL 61820-2101
(217) 403-5477
(217) 403-5476
Mailing address
819 BLOOMINGTON RD, CHAMPAIGN, IL 61820-2101
(217) 403-5477
(217) 403-5476
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019.030678
IL
Other
Enumeration date
06/16/2016
Last updated
06/16/2016
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