Provider Demographics
NPI:1497195127
Name:ANDREKUS, BRUCE FRANK (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:FRANK
Last Name:ANDREKUS
Suffix:
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 1:3726 ROOSEVELT RD
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53142-1900
Mailing Address - Country:US
Mailing Address - Phone:262-652-7956
Mailing Address - Fax:
Practice Address - Street 1:3726 ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-1900
Practice Address - Country:US
Practice Address - Phone:262-652-7956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-26
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3650 WI1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice