| Organization Name: | BRIAN E. ANDERSON, D.D.S., PLLC |
| NPI Number: | 1063796456 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | BRIAN EDWARD ANDERSON (SOLE MEMBER) |
| Mailing Address: | 125 N. Pansy St Ishpeming |
| State: | MI US |
| Postal Code: | 49849 |
| Phone Number: | 9064855575 |
| Fax Number: | 9064851260 |
| NPI Enumeration Date: | 10/04/2011 |
| NPI Last Update Date: | 10/04/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | 2901019979 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |