Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | VA 4592 | VA |
NPI | 1114035573 |
---|---|
Provider Name | Dr. David Carlson Anderson |
First Address | Alexandria, VA 22311 |
Second Address | Alexandria, VA 22311 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/08/2006 |
Last Update Date | 08/07/2007 |