Provider Demographics
NPI:1023546926
Name:ANDALORO, JOSHUA MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:MICHAEL
Last Name:ANDALORO
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 1:14148 MAYFIELD ST
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-4127
Mailing Address - Country:US
Mailing Address - Phone:734-776-4613
Mailing Address - Fax:
Practice Address - Street 1:1221 E SHERMAN BLVD
Practice Address - Street 2:
Practice Address - City:NORTON SHORES
Practice Address - State:MI
Practice Address - Zip Code:49444-1811
Practice Address - Country:US
Practice Address - Phone:231-739-5105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010223641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice