Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 5956 | WI |
NPI | 1083624621 |
---|---|
Provider Name | Dr. David Charles Anderson |
First Address | Appleton, WI 54913 |
Second Address | Green Bay, WI 54301-5115 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
33798200 | (05) | WI |