Provider Demographics
NPI:1114769395
Name:ANDERSON, NATALIE RUETH (DMD)
Entity type:Individual
Prefix:DR
First Name:NATALIE
Middle Name:RUETH
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:622 MARGAUX CT
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-8803
Mailing Address - Country:US
Mailing Address - Phone:219-775-0103
Mailing Address - Fax:
Practice Address - Street 1:7101 E LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-8821
Practice Address - Country:US
Practice Address - Phone:219-775-0103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12014480A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist