Provider Demographics
NPI:1043373210
Name:CHRISMAN, ANDREW BETH (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:BETH
Last Name:CHRISMAN
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 1:704 N 17TH STREET
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-3905
Mailing Address - Country:US
Mailing Address - Phone:208-344-0134
Mailing Address - Fax:208-388-3990
Practice Address - Street 1:704 N 17TH STREET
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-3905
Practice Address - Country:US
Practice Address - Phone:208-344-0134
Practice Address - Fax:208-388-3990
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD 19351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID6P102OtherBLUE CROSS