Provider Demographics
NPI:1477840502
Name:BEANAN, ANDREA MARIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:MARIE
Last Name:BEANAN
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 1:2185 BULLIS RD
Mailing Address - Street 2:P.O. BOX 86
Mailing Address - City:ELMA
Mailing Address - State:NY
Mailing Address - Zip Code:14059-9200
Mailing Address - Country:US
Mailing Address - Phone:716-652-0411
Mailing Address - Fax:
Practice Address - Street 1:2185 BULLIS RD
Practice Address - Street 2:
Practice Address - City:ELMA
Practice Address - State:NY
Practice Address - Zip Code:14059-9200
Practice Address - Country:US
Practice Address - Phone:716-652-0411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-10
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0562421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice