Provider Demographics
NPI:1073869137
Name:WILLEFORD, ANDE B (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDE
Middle Name:B
Last Name:WILLEFORD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1502 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:OK
Mailing Address - Zip Code:73533-4333
Mailing Address - Country:US
Mailing Address - Phone:580-252-9422
Mailing Address - Fax:580-252-9511
Practice Address - Street 1:1502 W MAIN ST
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533-4333
Practice Address - Country:US
Practice Address - Phone:580-252-9422
Practice Address - Fax:580-252-9511
Is Sole Proprietor?:No
Enumeration Date:2012-07-26
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK442621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice