Provider Demographics
NPI:1174746697
Name:ANDERSON, ALAN H (DDS)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:H
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7931 SHAGGY MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:HERRIMAN
Mailing Address - State:UT
Mailing Address - Zip Code:84065-3676
Mailing Address - Country:US
Mailing Address - Phone:801-446-7047
Mailing Address - Fax:
Practice Address - Street 1:1758 W 4805 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84118-1177
Practice Address - Country:US
Practice Address - Phone:801-964-6699
Practice Address - Fax:801-964-1347
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT142218122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist