Provider Demographics
NPI:1568481760
Name:JAMES C. E. ANDREA AND LYNNETTE K. E. ANDREA
Entity Type:Organization
Organization Name:JAMES C. E. ANDREA AND LYNNETTE K. E. ANDREA
Other - Org Name:VADNAIS HEIGHTS FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:C E
Authorized Official - Last Name:ANDREA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:651-482-0180
Mailing Address - Street 1:1230 COUNTY ROAD E E
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55110-5132
Mailing Address - Country:US
Mailing Address - Phone:651-482-0180
Mailing Address - Fax:651-482-7957
Practice Address - Street 1:1230 COUNTY ROAD E E
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55110-5132
Practice Address - Country:US
Practice Address - Phone:651-482-0180
Practice Address - Fax:651-482-7957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN100991223G0001X
MN99591223G0001X
MN114891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty