Individual
JOHN D ANDERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
13215 BIRCH ST, SUITE 100, OMAHA, NE 68164-5431
(402) 390-0770
Mailing address
201 RIDGE ST, SUITE 308, COUNCIL BLUFFS, IA 51503-4643
(712) 328-8892
(712) 328-8845
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
7220
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0249052
—
IA
Enumeration date
09/07/2006
Last updated
12/22/2007
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