Provider Demographics
NPI:1558402677
Name:PILGRIM, ANDREW LORRY (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:LORRY
Last Name:PILGRIM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1823 BOSTON POST RD
Mailing Address - Street 2:PO BOX 94
Mailing Address - City:WESTBROOK
Mailing Address - State:CT
Mailing Address - Zip Code:06498-2048
Mailing Address - Country:US
Mailing Address - Phone:860-399-7971
Mailing Address - Fax:860-399-4453
Practice Address - Street 1:1823 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:WESTBROOK
Practice Address - State:CT
Practice Address - Zip Code:06498-2048
Practice Address - Country:US
Practice Address - Phone:860-399-7971
Practice Address - Fax:860-399-4453
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT59831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice