Provider Demographics
NPI:1548304884
Name:ANDERSON, ERIC SCOTT (DDS)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:SCOTT
Last Name:ANDERSON
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 1:8027 SPRINGSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84098-4614
Mailing Address - Country:US
Mailing Address - Phone:435-649-9177
Mailing Address - Fax:801-261-7459
Practice Address - Street 1:292 E 3900 S
Practice Address - Street 2:STE 7
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-1557
Practice Address - Country:US
Practice Address - Phone:801-262-0807
Practice Address - Fax:801-261-7459
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4827096-99231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice