Kenneth Mark Anderson, DDS,MS

Primary specialty

Oral and Maxillofacial Pathology DentistryTaxonomy code 1223P0106X

License

DDS8053 Issued in TN

Practice address

875 Union Ave
Room C309
Memphis, TN 38163-0001

Phone

(901) 448-5876

Fax

(901) 448-6835

NPI assigned

Oct 27, 2006

Last updated

Sep 5, 2019By 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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• University of Tennessee

  • Family Medicine Physician
  • Jackson, TN
  • NPI 1780686436
  Medicare reassignment NPD
• University of Tennessee

  dba Univ. of TN Health Science Center College of Nursing

  • Family Nurse Practitioner
  • Memphis, TN
  • NPI 1174221337
  NPD
• University of Tennessee

  • Oral and Maxillofacial Surgery (Dentist)
  • Memphis, TN
  • NPI 1215012430
  NPD

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

{
    "created_epoch": "1161907200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1567641600000",
    "number": "1245316017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "875 UNION AVE RM C309",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381632110",
            "telephone_number": "901-448-2569",
            "fax_number": "901-448-6835"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "875 UNION AVE",
            "address_2": "ROOM C309",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381630001",
            "telephone_number": "901-448-5876",
            "fax_number": "901-448-6835"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "KENNETH",
        "middle_name": "MARK",
        "name_prefix": "Dr.",
        "credential": "DDS,MS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-27",
        "last_updated": "2019-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0106X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Pathology",
            "state": "TN",
            "license": "DDS8053",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "4075323",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gregory Anderson, M.D.
• James Harold Anderson, DMD
• Janice Lynn Anderson, LPC-MHSP
• Katherine Anderson
• Kendall Anderson
• Khastity Anderson
• Kristin K Anderson, OD
• Kyrstan Anderson, LPC-MHSP
• Lanetta Anderson, MD
• Mary Garraway Anderson

• Oral and Maxillofacial Pathology Dentistry in Memphis, TN
• Providers in Memphis, TN by specialty
• Oral and Maxillofacial Pathology Dentistry in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.