Provider Demographics
NPI:1497968341
Name:PRIVITERA, ANDREW P (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:P
Last Name:PRIVITERA
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 1:595 ERIE AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-4404
Mailing Address - Country:US
Mailing Address - Phone:716-693-3997
Mailing Address - Fax:716-693-2808
Practice Address - Street 1:595 ERIE AVE
Practice Address - Street 2:
Practice Address - City:NORTH TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14120-4404
Practice Address - Country:US
Practice Address - Phone:716-693-3997
Practice Address - Fax:716-693-2808
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0465611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01773826Medicaid