Individual
MR. CHARLES W ANDERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D
Contact information
Practice address
1244 5TH ST, SUITE 4, JELLICO, TN 37762-2630
(423) 784-3587
(423) 784-7730
Mailing address
1244 5TH ST, SUITE 4, JELLICO, TN 37762-2630
(423) 784-3587
(423) 784-7730
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4143
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
60055258
—
KY
Enumeration date
12/08/2005
Last updated
07/08/2007
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