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Individual

DR. GERALD ELLIS ANDERSON

Active
Sole proprietor

Provider details

NPI number
Gender
Man
Credential
D.M.D.

Contact information

Practice address
3975 RIVER RD N, SUITE #5, KEIZER, OR 97303-4811
(503) 393-9106
(503) 393-3053
Mailing address
3975 RIVER RD N, SUITE #5, KEIZER, OR 97303-4811
(503) 393-9106
(503) 393-3053

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D4704
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00454-9
OR
01
0250011-8
OREGON BUSINESS ID #
OR
01
D4704
OREGON DENTAL LICENSE #
OR
Enumeration date
07/08/2005
Last updated
07/09/2007
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