Individual
MATTHEW ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
12165 ELM ST, PRINCESS ANNE, MD 21853-1358
(410) 651-5151
Mailing address
12165 ELM ST, PRINCESS ANNE, MD 21853-1358
(410) 651-5151
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
LL632
MD
122300000X
Dentist
LL673
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
119591300
—
MD
Enumeration date
07/16/2012
Last updated
10/05/2018
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