Provider Demographics
NPI:1861571911
Name:ANDERSON, DALE MICHAEL (DDS)
Entity type:Individual
Prefix:DR
First Name:DALE
Middle Name:MICHAEL
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 1:8080 MANITOU DR
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-9701
Mailing Address - Country:US
Mailing Address - Phone:614-882-6563
Mailing Address - Fax:
Practice Address - Street 1:137 W SCHROCK RD
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-2831
Practice Address - Country:US
Practice Address - Phone:614-882-6003
Practice Address - Fax:614-882-6244
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300134261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice