Provider Demographics
NPI:1043548415
Name:PETER T. ANDOLINO DMD PC
Entity Type:Organization
Organization Name:PETER T. ANDOLINO DMD PC
Other - Org Name:PETER T. ANDOLINO DMD PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:T
Authorized Official - Last Name:ANDOLINO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:610-691-6200
Mailing Address - Street 1:627 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-5220
Mailing Address - Country:US
Mailing Address - Phone:610-691-6200
Mailing Address - Fax:
Practice Address - Street 1:627 W BROAD ST
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-5220
Practice Address - Country:US
Practice Address - Phone:610-691-6200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-24
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0359961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty