Individual
MICHAEL ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
2033 E SUMMERSWEET DR, BOISE, ID 83716-6695
(208) 331-0182
(208) 331-0184
Mailing address
2033 E SUMMERSWEET DR, BOISE, ID 83716-6695
(208) 331-0182
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D4324
ID
Other
Enumeration date
08/11/2010
Last updated
08/11/2010
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