Provider Demographics
NPI:1437888187
Name:DRAGOMER, ANDREI SORIN III (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDREI
Middle Name:SORIN
Last Name:DRAGOMER
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:547 CANTERBURY RD
Mailing Address - Street 2:
Mailing Address - City:GRIFFITH
Mailing Address - State:IN
Mailing Address - Zip Code:46319-3050
Mailing Address - Country:US
Mailing Address - Phone:219-682-4150
Mailing Address - Fax:
Practice Address - Street 1:1720 TAMIAMI TRL STE 102
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33948-1121
Practice Address - Country:US
Practice Address - Phone:941-584-8926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-08
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN26917122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist