Provider Demographics
NPI:1992303242
Name:ANDERSON DENTAL ASSOCIATES III, PLLC
Entity type:Organization
Organization Name:ANDERSON DENTAL ASSOCIATES III, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:WILFREDO
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-817-2787
Mailing Address - Street 1:2719 WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22201-1942
Mailing Address - Country:US
Mailing Address - Phone:703-243-1810
Mailing Address - Fax:703-243-1874
Practice Address - Street 1:15609 WINGSPAN CT
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22193-1103
Practice Address - Country:US
Practice Address - Phone:860-817-2787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-09
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental