Provider Demographics
NPI:1124028113
Name:MILLER FINCH, ANDREA M (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:M
Last Name:MILLER FINCH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:ANDREA
Other - Middle Name:M
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:1625 W NORTH AVE APT 1A-1E
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-8415
Mailing Address - Country:US
Mailing Address - Phone:312-208-4977
Mailing Address - Fax:312-208-4977
Practice Address - Street 1:1625 W NORTH AVE APT 1A-1E
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-8415
Practice Address - Country:US
Practice Address - Phone:312-208-4977
Practice Address - Fax:312-208-4977
Is Sole Proprietor?:No
Enumeration Date:2005-07-30
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019022059122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1002966Medicaid
IL1245401124OtherNPI TYPE 2 ORGANIZATION