Provider Demographics
NPI:1104029347
Name:ANDERSON, TAMMY L (DDS)
Entity type:Individual
Prefix:DR
First Name:TAMMY
Middle Name:L
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:TAMMY
Other - Middle Name:L
Other - Last Name:STURDEVANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:918 MARKET ST
Mailing Address - Street 2:PO BOX 328
Mailing Address - City:PERHAM
Mailing Address - State:MN
Mailing Address - Zip Code:56573
Mailing Address - Country:US
Mailing Address - Phone:218-346-7186
Mailing Address - Fax:218-346-7182
Practice Address - Street 1:918 MARKET ST
Practice Address - Street 2:PO BOX 328
Practice Address - City:PERHAM
Practice Address - State:MN
Practice Address - Zip Code:56573
Practice Address - Country:US
Practice Address - Phone:218-346-7186
Practice Address - Fax:218-346-7182
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND124051223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice