Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 8418211-9921 | UT |
N | 1223E0200X | Endodontist | D11375 | OR |
Y | 1223E0200X | Endodontist | DE60944562 | WA |
NPI | 1073864963 |
---|---|
Provider Name | Dr. Matthew Ross Anderson |
First Address | Vancouver, WA 98686-1412 |
Second Address | Vancouver, WA 98686-1412 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2012 |
Last Update Date | 10/05/2021 |