Individual
GREGORY A. ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
501 MAIN ST, SUITE 4, WILLISTON, ND 58801-5327
(701) 577-2261
Mailing address
PO BOX 1127, WILLISTON, ND 58802-1127
(701) 577-2261
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
1682
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1682
STATE LICENSE NUMBER
ND
05
—
40846
—
ND
Enumeration date
11/17/2006
Last updated
07/08/2007
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