Provider Demographics
NPI:1528137742
Name:ANDERSON, CHRISTOPHER DOUGLAS (DDS)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:DOUGLAS
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 1:504 N JACKSON ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:TULLAHOMA
Mailing Address - State:TN
Mailing Address - Zip Code:37388-3520
Mailing Address - Country:US
Mailing Address - Phone:931-461-9030
Mailing Address - Fax:
Practice Address - Street 1:504 N JACKSON ST
Practice Address - Street 2:SUITE 103
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-3520
Practice Address - Country:US
Practice Address - Phone:931-461-9030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS00000076761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice