Provider Demographics
NPI:1467417949
Name:CHEIFETZ, ANDREW TODD (DMD MED)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:TODD
Last Name:CHEIFETZ
Suffix:
Gender:M
Credentials:DMD MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 ROUTE 101A
Mailing Address - Street 2:COLONIAL PARK SUITE D
Mailing Address - City:AMHERST
Mailing Address - State:NH
Mailing Address - Zip Code:03031
Mailing Address - Country:US
Mailing Address - Phone:603-673-1000
Mailing Address - Fax:603-673-2422
Practice Address - Street 1:7 ROUTE 101A
Practice Address - Street 2:COLONIAL PARK SUITE D
Practice Address - City:AMHERST
Practice Address - State:NH
Practice Address - Zip Code:03031
Practice Address - Country:US
Practice Address - Phone:603-673-1000
Practice Address - Fax:603-673-2422
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH33471223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30302634Medicaid