Individual
DR. DAVID M ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS, MD
Contact information
Practice address
4660 W COLLEGE AVE, APPLETON, WI 54913-8507
(920) 730-0345
Mailing address
3327 N CASALOMA DR UNIT 198, APPLETON, WI 54913-7963
(608) 751-9915
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
1002515
WI
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
315501-9924
UT
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
315501-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
870679577
TAX-ID
UT
Enumeration date
10/03/2006
Last updated
11/24/2021
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