Provider Demographics
NPI:1093832669
Name:CRONIN, ANDREA VIRGINIA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:VIRGINIA
Last Name:CRONIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:ANDREA
Other - Middle Name:VIRGINIA
Other - Last Name:HAUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:255 S 17TH ST STE 2306
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-6223
Mailing Address - Country:US
Mailing Address - Phone:215-732-8080
Mailing Address - Fax:215-732-5565
Practice Address - Street 1:255 S 17TH ST STE 2306
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103
Practice Address - Country:US
Practice Address - Phone:856-691-2553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02342600122300000X
PADS036902122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist