Provider Demographics
NPI:1629434410
Name:ANDRAWIS, MARK S (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:S
Last Name:ANDRAWIS
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 1:5 BECKER FARM RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ROSELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:07068-1741
Mailing Address - Country:US
Mailing Address - Phone:973-974-9490
Mailing Address - Fax:973-974-9491
Practice Address - Street 1:5 BECKER FARM RD
Practice Address - Street 2:SUITE 101
Practice Address - City:ROSELAND
Practice Address - State:NJ
Practice Address - Zip Code:07068-1741
Practice Address - Country:US
Practice Address - Phone:973-974-9490
Practice Address - Fax:973-974-9491
Is Sole Proprietor?:No
Enumeration Date:2016-01-08
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02556300122300000X
NY058823-1122300000X
CODEN.00203003122300000X
VA040145409122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist