Individual
MATTHEW BOYD ANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
5189 UTICA RIDGE RD, DAVENPORT, IA 52807-3863
(563) 355-2010
(563) 355-3191
Mailing address
5189 UTICA RIDGE RD, DAVENPORT, IA 52807-3863
(563) 355-2010
(563) 355-3191
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
07892
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12002
BC/BS PROVIDER
IA
01
—
973821
UNITED CONCORDIA PROVIDER
IA
Enumeration date
08/11/2006
Last updated
07/08/2007
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