Individual
DR. THOR JASON ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1520 VERNON ST, STOUGHTON, WI 53589-2260
(608) 873-7277
Mailing address
1520 VERNON ST, STOUGHTON, WI 53589-2260
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4619-015
WI
Other
Enumeration date
09/28/2006
Last updated
07/08/2007
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