Provider Demographics
NPI:1861599201
Name:ANDERSON, STEVEN ANDREW (DMD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:ANDREW
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1675 SOUTH MAIN STREET
Mailing Address - Street 2:LAUREL MEDICAL CENTER, LOWER LEVEL
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741
Mailing Address - Country:US
Mailing Address - Phone:606-878-6126
Mailing Address - Fax:
Practice Address - Street 1:1675 SOUTH MAIN STREET
Practice Address - Street 2:LAUREL MEDICAL CENTER, LOWER LEVEL
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741
Practice Address - Country:US
Practice Address - Phone:606-878-6126
Practice Address - Fax:606-878-0840
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY66561223S0112X, 204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Not Answered204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY12# 0000000 50768OtherBCBS
KY60066560Medicaid
KYE604OtherANTHEM BCBS PROVIDER #
KY64066566Medicaid
KYU68800Medicare UPIN
KY1256606Medicare ID - Type UnspecifiedCORBIN LOCATION
KY3670Medicare ID - Type UnspecifiedLONDON LOCATION - GROUP #
KY60066560Medicaid
KY0367004Medicare ID - Type UnspecifiedLONDON LOCATION