Organization
ANDERSON DENTAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES W ANDERSON D.D.S (OWNER/PRESIDENT)
(512) 264-9977
Entity
Organization
Contact information
Practice address
22106 HWY 71 W, SPICEWOOD, TX 78669-6115
(512) 264-9977
(512) 264-9517
Mailing address
22106 HWY 71 W, SPICEWOOD, TX 78669-6115
(512) 264-9977
(512) 264-9517
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
9754
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
007989902
—
TX
Enumeration date
02/04/2009
Last updated
02/04/2009
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