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Provider Information for 1124266788

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DR. TOD CHRISTIAN ANDERSON D.D.S

Gender: MALE

Individual NPI: 1124266788

Calendar Last Updated: 2009-11-20

Details

Name Value
NPI 1124266788
Enumeration Date 2009-02-04
NPI Type 1 - Individual
Sole Proprietor YES
Status Active
Mailing Address 4145 PORTOLA DR. APT. #202
SANTA CRUZ, CA 95062-4505
United States

Phone: 831-600-8081 | Fax:
View Map External Link
Primary Practice Address 9520 SOQUEL DR
APTOS, CA 95003-4160
United States

Phone: 831-688-1006 | Fax:
View Map External Link
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 122300000X - Dentist CA 56685
Other Identifiers
Issuer State Number
MEDICAID CA 1295810174
Endpoint Information
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location