Provider Demographics
NPI:1164509972
Name:ANDOLINO, PETER THOMAS (DMD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:THOMAS
Last Name:ANDOLINO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:627 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-5220
Mailing Address - Country:US
Mailing Address - Phone:484-991-8258
Mailing Address - Fax:
Practice Address - Street 1:627 W BROAD ST
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-5220
Practice Address - Country:US
Practice Address - Phone:610-691-6200
Practice Address - Fax:610-691-1840
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0359961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice