Robert William Anderson Jr., DMD
Individual provider Active NPI Dentist · Waltham, MA
NPI 1154094472 · NPPES record last updated Aug 2, 2021
Key facts
- NPI
- 1154094472
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- DN1859101 (MA)
- Practice address
- 862 Lexington St
Waltham, MA 02452-4849 - Phone
- (781) 684-9714
- NPI assigned
- Aug 2, 2021
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN1859101 | MA | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Waltham Modern Dentistry, PC | Dentist | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DN1859101 | MA | Yes |
Addresses
Primary practice location
862 Lexington St
Waltham, MA 02452-4849
Mailing address
15 Clarendon St
Newton, MA 02460-2020
Phone (617) 956-2322
Other providers in Waltham, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 2, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.