Provider Demographics
NPI:1205894193
Name:ANDERSEN, DAVID ERIC (DDS)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:ERIC
Last Name:ANDERSEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19033 U.S. 71
Mailing Address - Street 2:
Mailing Address - City:PARK RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:56470
Mailing Address - Country:US
Mailing Address - Phone:218-732-3291
Mailing Address - Fax:
Practice Address - Street 1:19033 U.S. 71
Practice Address - Street 2:
Practice Address - City:PARK RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:56470
Practice Address - Country:US
Practice Address - Phone:218-732-3291
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND107191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice