Alan Michael Anderson, D.M.D.
Individual provider Active NPI General Practice Dentistry · Bishop, CA
NPI 1972697134 · NPPES record last updated Jun 24, 2009
Key facts
- NPI
- 1972697134
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 35066 (CA)
- Practice address
- 52 N Tu Su LN
Bishop, CA 93514-8058 - Phone
- (760) 873-3443
- NPI assigned
- Oct 3, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- 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 |
|---|---|---|---|---|
| I20150603000149 | CA | Order and Referring Only - Dentist |
1850612862 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35066 | CA | MD | Pediatric Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Toiyabe Indian Health Project, Inc | Past | Accepting new patients | |
| Toiyabe Indian Health Project, Inc | Past | Accepting new patients |
Interoperability endpoints
- https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
- alan.anderson.d1.p1@direct.toiyabe.nextgenshare.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 35066 | CA | Yes |
Addresses
Primary practice location
52 N Tu Su LN
Bishop, CA 93514-8058
Mailing address
1105 E 1050 N
Heber City, UT 84032-3474
Other providers in Bishop, CA
- Eryn T Aldrich Coffey
- Lois Alexander
- All Ears Hearing Center
- Ruby Sharon Allen
- Keith J Andersen
- Tabiya Andrade
- Andrew D. Hewchuck, D.P.M., Inc.
- Apx Orthopaedics, a Professional Medical Corporation
- Rebekah A Armstrong
- Amber Michelle Arnsten
All providers in Bishop, CA · General Practice Dentistry in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 24, 2009. 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.