Jon D Anderson, DDS
Individual provider Active NPI General Practice Dentistry · Fargo, ND
NPI 1669554341 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1669554341
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 1601 (ND)
- Practice address
- 2538 University Dr S
Ste B
Fargo, ND 58103-5737 - Phone
- (701) 232-1368
- Fax
- (701) 232-4746
- NPI assigned
- Oct 20, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ND
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20151119002495 | ND | Order and Referring Only - Dentist |
7517267743 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1601 | ND | MD | Physical Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 1601 | ND | Yes |
Addresses
Primary practice location
2538 University Dr S
Ste B
Fargo, ND 58103-5737
Mailing address
2538 University Dr S
Ste B
Fargo, ND 58103-5737
Phone (701) 232-1368
Other providers in Fargo, ND
- Jadean Jake Anderson
- Jamie Anderson
- Jennifer Lenore Anderson
- Joan M Anderson
- Joelle Denise Anderson
- Justin Earl Anderson
- Kalli Anderson
- Kittery Anderson
- Leah Anderson
- Lindsay Nichole Anderson
All providers in Fargo, ND · General Practice Dentistry in North Dakota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.