Roger Wynn Anderson, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

33720 Issued in CA

Practice address

1477 San Marino Avenue
Suite 1
San Marino, CA 91108-2053

Phone

(625) 796-6371

Fax

(626) 449-6947

NPI assigned

Dec 18, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166400000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1184787657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1477 SAN MARINO AVENUE",
            "address_2": "SUITE 1",
            "city": "SAN MARINO",
            "state": "CA",
            "postal_code": "911082053",
            "telephone_number": "625-796-6371",
            "fax_number": "626-449-6947"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1477 SAN MARINO AVENUE",
            "address_2": "SUITE 1",
            "city": "SAN MARINO",
            "state": "CA",
            "postal_code": "911082053",
            "telephone_number": "625-796-6371",
            "fax_number": "626-449-6947"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "ROGER",
        "middle_name": "WYNN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-18",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "33720",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Susan Albinger, OTR/L
• Christopher Alegria, D.C.
• Samantha Ashley Alexander
• Elisa C Alvarado, M.D.
• Americans for Better Health Ipa
• Antonio Liu MD Apc
• Apcn-Aco, a Medical Professional Corp
• Arbela Dialysis LLC (San Marino Home Training)
• Avante Best Care Ipa
• Barbara Huynh, D.O., Inc.

• General Practice Dentistry in San Marino, CA
• Providers in San Marino, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.