Provider Demographics
NPI:1487749719
Name:ANDERSON, PAUL NORMAN (DDS)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:NORMAN
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13195 WARWICK BLVD
Mailing Address - Street 2:SUITE #1A
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23602-8312
Mailing Address - Country:US
Mailing Address - Phone:757-874-4007
Mailing Address - Fax:757-877-1755
Practice Address - Street 1:13195 WARWICK BLVD
Practice Address - Street 2:SUITE #1A
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602-8312
Practice Address - Country:US
Practice Address - Phone:757-874-4007
Practice Address - Fax:757-877-1755
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010080241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice