Provider Demographics
NPI:1699788950
Name:ANDERSON, STEVEN PAUL (DDS)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:PAUL
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 1:2208 E 52ND ST STE A
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-2726
Mailing Address - Country:US
Mailing Address - Phone:563-359-5599
Mailing Address - Fax:
Practice Address - Street 1:2208 E 52ND ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-2726
Practice Address - Country:US
Practice Address - Phone:563-359-5599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA65291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice