Individual
JENNIFER L ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
208 N. WALNUT AVE, FORRESTON, IL 61030
(815) 938-2575
(815) 938-2363
Mailing address
PO BOX 368, 208 N. WALNUT AVE, FORRESTON, IL 61030
(815) 938-2575
(815) 938-2363
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019028537
IL
1223G0001X
General Practice Dentistry
6410
WI
Other
Enumeration date
06/12/2009
Last updated
01/03/2013
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