Provider Demographics
NPI:1558529149
Name:YENTZ, ANDREA LYNN OSWALD (DDS)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:LYNN OSWALD
Last Name:YENTZ
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 1:1080 N MONROE ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48162-3193
Mailing Address - Country:US
Mailing Address - Phone:734-242-8885
Mailing Address - Fax:734-242-1410
Practice Address - Street 1:1080 N MONROE ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-3193
Practice Address - Country:US
Practice Address - Phone:734-242-8885
Practice Address - Fax:734-242-1410
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-30
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300228331223G0001X
MI29010199341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice