L. Eric Anderson

Individual provider Active NPI General Practice Dentistry · West Des Moines, IA

NPI 1912928375 · NPPES record last updated Jul 8, 2007

Key facts

NPI
1912928375
Entity type
Individual (NPI type 1)
Primary specialty
General Practice Dentistry 1223G0001X
License
8004 (IA)
Practice address
2501 Westown Pkwy
West Des Moines, IA 50266-1438
Phone
(515) 276-8572
Fax
(515) 334-7274
NPI assigned
Jul 21, 2006
Sex
Male
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
8004IAMDGeneral Practice Dentistry

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 8004 IA Yes

Addresses

Primary practice location

2501 Westown Pkwy
West Des Moines, IA 50266-1438

Mailing address

8232 Chambery Blvd
Johnston, IA 50131-8773
Phone (515) 270-2270

Other identifiers

IdentifierTypeStateIssuer
22249OtherIAWELLMARK BCBS

Other providers in West Des Moines, IA

All providers in West Des Moines, IA · General Practice Dentistry in Iowa

Sources for this page

Verify at the official NPI Registry.