Provider Demographics
NPI:1407376742
Name:CSOK, ANDREA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:
Last Name:CSOK
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 1:1220 GOLDEN GATE BLVD
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-1819
Mailing Address - Country:US
Mailing Address - Phone:440-463-1144
Mailing Address - Fax:
Practice Address - Street 1:320 WINDSOR DR
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:OH
Practice Address - Zip Code:44410-2705
Practice Address - Country:US
Practice Address - Phone:330-974-0850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-27
Last Update Date:2017-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.025099122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist