Matthew Ron Anderson, D.M.D.

Primary specialty

DentistTaxonomy code 122300000X

License

61202 Issued in CA

Practice address

90 Doctors Park
Suite B
Santa Rosa, CA 94505

Phone

(707) 526-3303

NPI assigned

Apr 5, 2012

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

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1333584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1398643200000",
    "number": "1710243688",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "90 DOCTORS PARK",
            "address_2": "SUITE B",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "94505",
            "telephone_number": "707-526-3303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "90 DOCTORS PARK",
            "address_2": "SUITE B",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "94505",
            "telephone_number": "707-526-3303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "MATTHEW",
        "middle_name": "RON",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-04-05",
        "last_updated": "2014-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "61202",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Heather Yvadne Anderson, D.D.S.
• Ian Churchill Anderson, M.D.
• Jacqueline Anderson
• Laurel S Anderson
• Lauren Anderson, RN
• Michael Anderson, PHARMD
• Nicole Anderson, L.AC.
• Robert Carl Anderson
• Robert Louis Anderson, M.D.
• Robin Anderson, PSYD

• Dentist in Santa Rosa, CA
• Providers in Santa Rosa, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2014; 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.