Individual
JANTZEN LYNN ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
5430 TUTT BLVD, COLORADO SPRINGS, CO 80922-2515
(719) 591-5437
Mailing address
5430 TUTT BLVD, COLORADO SPRINGS, CO 80922-2515
(719) 591-5437
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
0024713
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0024713
TEXAS DENTAL LICENSE
TX
01
—
10747
COLORADO DENTAL LICENSE
CO
Enumeration date
06/14/2009
Last updated
07/13/2012
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