Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 15020 | OH |
NPI | 1023119344 |
---|---|
Provider Name | Dr. Ronnie Lee Anderson |
First Address | Springfield, OH 45503-2737 |
Second Address | Springfield, OH 45503-2737 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2006 |
Last Update Date | 08/07/2007 |