Individual
LISA Y ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
12750 SE STARK ST BLDG E, PORTLAND, OR 97233-1539
(971) 347-3009
(971) 256-3277
Mailing address
1776 SW MADISON ST, PORTLAND, OR 97205-1715
(503) 224-1044
(503) 621-2235
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D10511
OR
1223G0001X
General Practice Dentistry
D10511
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2162830
—
WA
05
—
500718237
—
OR
Enumeration date
07/26/2016
Last updated
09/12/2024
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