Provider Demographics
NPI:1285806711
Name:ANDERSON, ERNIE FOREST (DDS)
Entity type:Individual
Prefix:DR
First Name:ERNIE
Middle Name:FOREST
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:ERNIE
Other - Middle Name:F
Other - Last Name:ANDERSON, DDS, INC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:5315 B FM 1960 W
Mailing Address - Street 2:#152
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77069
Mailing Address - Country:US
Mailing Address - Phone:281-205-9162
Mailing Address - Fax:281-379-2002
Practice Address - Street 1:5315 B FM 1960 W
Practice Address - Street 2:#152
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77069
Practice Address - Country:US
Practice Address - Phone:281-205-9162
Practice Address - Fax:281-379-2002
Is Sole Proprietor?:No
Enumeration Date:2008-03-25
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX09470122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist