Provider Demographics
NPI:1144399593
Name:MARCHESE, ANDREW L JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:L
Last Name:MARCHESE
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5635 STATE RD
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:IL
Mailing Address - Zip Code:60459-2051
Mailing Address - Country:US
Mailing Address - Phone:630-832-5623
Mailing Address - Fax:
Practice Address - Street 1:5635 STATE RD
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:IL
Practice Address - Zip Code:60459-2051
Practice Address - Country:US
Practice Address - Phone:708-424-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19-17914122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist