Provider Demographics
NPI:1336469535
Name:MCENTEE, ANDREW T (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:T
Last Name:MCENTEE
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 1:1891 MAINE ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-4272
Mailing Address - Country:US
Mailing Address - Phone:217-223-7051
Mailing Address - Fax:217-223-7429
Practice Address - Street 1:1891 MAINE ST
Practice Address - Street 2:SUITE 1
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-4272
Practice Address - Country:US
Practice Address - Phone:217-223-7051
Practice Address - Fax:217-223-7429
Is Sole Proprietor?:No
Enumeration Date:2010-06-10
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019028326122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist