Provider Demographics
NPI:1649372798
Name:ANDERSON, DONALD G (DDS MS)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:G
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:DDS MS
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Mailing Address - Street 1:3105 E 98TH ST
Mailing Address - Street 2:SUITE 130
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46280-2005
Mailing Address - Country:US
Mailing Address - Phone:317-569-9977
Mailing Address - Fax:317-569-9988
Practice Address - Street 1:3105 E 98TH ST
Practice Address - Street 2:SUITE 130
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46280-2005
Practice Address - Country:US
Practice Address - Phone:317-569-9977
Practice Address - Fax:317-569-9988
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2010-11-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN120098051223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN12009805OtherINDIANA DENTAL LICENSE