Provider Demographics
NPI:1588976856
Name:ANDERSON, HAROLD BENJAMIN (DDS)
Entity type:Individual
Prefix:
First Name:HAROLD
Middle Name:BENJAMIN
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 1:11900 GRANT ST STE 300
Mailing Address - Street 2:
Mailing Address - City:NORTHGLENN
Mailing Address - State:CO
Mailing Address - Zip Code:80233-1117
Mailing Address - Country:US
Mailing Address - Phone:720-640-7382
Mailing Address - Fax:720-640-7383
Practice Address - Street 1:11900 GRANT ST STE 300
Practice Address - Street 2:
Practice Address - City:NORTHGLENN
Practice Address - State:CO
Practice Address - Zip Code:80233-1117
Practice Address - Country:US
Practice Address - Phone:720-640-7382
Practice Address - Fax:720-640-7383
Is Sole Proprietor?:No
Enumeration Date:2010-07-02
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901020221122300000X
INLDR180208122300000X
CO002050501223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM06406751Medicaid