Provider Demographics
NPI:1548795545
Name:GORDON, ANDRIANETTE NICOLE (DDS)
Entity Type:Individual
Prefix:MRS
First Name:ANDRIANETTE
Middle Name:NICOLE
Last Name:GORDON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MRS
Other - First Name:ANDRIANETTE
Other - Middle Name:NICOLE
Other - Last Name:SKRYPEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:4330 MAPLE RD.
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14226
Mailing Address - Country:US
Mailing Address - Phone:716-362-4800
Mailing Address - Fax:
Practice Address - Street 1:4330 MAPLE RD.
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14226
Practice Address - Country:US
Practice Address - Phone:716-362-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-27
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY0597411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program