Provider Demographics
NPI:1194835538
Name:ANDERSON, RICHARD L (DDS PC)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:L
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:DDS PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3505 AUSTIN BLUFFS PKWY
Mailing Address - Street 2:#302
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918
Mailing Address - Country:US
Mailing Address - Phone:719-598-0946
Mailing Address - Fax:719-598-7279
Practice Address - Street 1:3505 AUSTIN BLUFFS PKWY
Practice Address - Street 2:#302
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918
Practice Address - Country:US
Practice Address - Phone:719-598-0946
Practice Address - Fax:719-598-7279
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3344122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist