Provider Demographics
NPI:1225065295
Name:KRESSLEY, ANDREW J (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:J
Last Name:KRESSLEY
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 1:1480 BOSTON POST RD
Mailing Address - Street 2:
Mailing Address - City:OLD SAYBROOK
Mailing Address - State:CT
Mailing Address - Zip Code:06475
Mailing Address - Country:US
Mailing Address - Phone:860-388-5745
Mailing Address - Fax:860-388-2145
Practice Address - Street 1:1480 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:OLD SAYBROOK
Practice Address - State:CT
Practice Address - Zip Code:06475
Practice Address - Country:US
Practice Address - Phone:860-388-5745
Practice Address - Fax:860-388-2145
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTD7920204E00000X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
U42000Medicare UPIN
19000804Medicare ID - Type Unspecified