Provider Demographics
NPI:1205854551
Name:ANDRICSAK, CATHY M (DMD)
Entity Type:Individual
Prefix:DR
First Name:CATHY
Middle Name:M
Last Name:ANDRICSAK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 HOOPER AVE
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-7754
Mailing Address - Country:US
Mailing Address - Phone:732-244-3444
Mailing Address - Fax:732-244-1225
Practice Address - Street 1:418 HOOPER AVE
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-7754
Practice Address - Country:US
Practice Address - Phone:732-244-3444
Practice Address - Fax:732-244-1225
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI01485100122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist