Provider Demographics
NPI:1578631107
Name:TRATTNER, ANDREA NICHOLE (RDH)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:NICHOLE
Last Name:TRATTNER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6340 AMERICANA DR
Mailing Address - Street 2:#918
Mailing Address - City:WILLOWBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60527
Mailing Address - Country:US
Mailing Address - Phone:630-850-9046
Mailing Address - Fax:
Practice Address - Street 1:55 E LOOP RD
Practice Address - Street 2:STE 201 GROVE DENTAL
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187
Practice Address - Country:US
Practice Address - Phone:630-853-8899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist