Provider Demographics
NPI:1023276862
Name:ANDERSEN, ROBERT (DMD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:ANDERSEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:MT
Mailing Address - Zip Code:59047-2624
Mailing Address - Country:US
Mailing Address - Phone:406-222-1111
Mailing Address - Fax:406-823-6305
Practice Address - Street 1:19 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BELGRADE
Practice Address - State:MT
Practice Address - Zip Code:59714-3715
Practice Address - Country:US
Practice Address - Phone:406-922-0820
Practice Address - Fax:406-823-6305
Is Sole Proprietor?:No
Enumeration Date:2008-05-29
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2257122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist