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Individual

DR. KENNETH MARK ANDERSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DDS,MS

Contact information

Practice address
875 UNION AVE, ROOM C309, MEMPHIS, TN 38163-0001
(901) 448-5876
(901) 448-6835
Mailing address
875 UNION AVE RM C309, MEMPHIS, TN 38163-2110
(901) 448-2569
(901) 448-6835

Taxonomy

Speciality
Code
Description
License number
State
1223P0106X
Oral and Maxillofacial Pathology Dentistry
Primary
DDS8053
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
4075323
BCBS
TN
Enumeration date
10/27/2006
Last updated
09/05/2019
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