Provider Demographics
NPI:1306221452
Name:SCOLLARD, ANDREA R (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:R
Last Name:SCOLLARD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 SANDALWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WILBRAHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01095-1544
Mailing Address - Country:US
Mailing Address - Phone:225-921-9793
Mailing Address - Fax:
Practice Address - Street 1:46 DAGGETT DR STE 2C
Practice Address - Street 2:
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-4646
Practice Address - Country:US
Practice Address - Phone:225-921-9793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-29
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18576811223G0001X
LA66011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice