Provider Demographics
NPI:1063672236
Name:D'ADDARIO, ANDREA TAPP (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:TAPP
Last Name:D'ADDARIO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6071 E WOODMEN RD
Mailing Address - Street 2:STE 200
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80923-2607
Mailing Address - Country:US
Mailing Address - Phone:719-638-7673
Mailing Address - Fax:
Practice Address - Street 1:6071 E WOODMEN RD
Practice Address - Street 2:STE 200
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80923-2607
Practice Address - Country:US
Practice Address - Phone:719-638-7673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-11
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2618122300000X
CO9798122300000X
OH30-022876122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist