Provider Demographics
NPI:1457468217
Name:DILL, ANDREW JOSEPH (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:JOSEPH
Last Name:DILL
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 1:1251 STRASSNER DR
Mailing Address - Street 2:UNIT 2202
Mailing Address - City:BRENTWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63144-1880
Mailing Address - Country:US
Mailing Address - Phone:502-368-2348
Mailing Address - Fax:
Practice Address - Street 1:2050 BLUESTONE DR
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63303-5977
Practice Address - Country:US
Practice Address - Phone:636-946-5225
Practice Address - Fax:636-946-5005
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY83941223G0001X
MO20100157361223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice