Provider Demographics
NPI:1407335409
Name:ANDRADE, EMILY C (DMD)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:C
Last Name:ANDRADE
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 1:2596 CARAMBOLA CIR N
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33066-2422
Mailing Address - Country:US
Mailing Address - Phone:954-993-8325
Mailing Address - Fax:
Practice Address - Street 1:6063 SW 18TH ST
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-7118
Practice Address - Country:US
Practice Address - Phone:561-349-4972
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-09
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN236331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice