Provider Demographics
NPI:1659682409
Name:ANDRE, EMILY (DMD, NMD, IBDM)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:
Last Name:ANDRE
Suffix:
Gender:F
Credentials:DMD, NMD, IBDM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1813 WILSON ST
Mailing Address - Street 2:
Mailing Address - City:MENOMONIE
Mailing Address - State:WI
Mailing Address - Zip Code:54751-1406
Mailing Address - Country:US
Mailing Address - Phone:715-600-9004
Mailing Address - Fax:
Practice Address - Street 1:1813 WILSON ST
Practice Address - Street 2:
Practice Address - City:MENOMONIE
Practice Address - State:WI
Practice Address - Zip Code:54751-1406
Practice Address - Country:US
Practice Address - Phone:715-600-9004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-27
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 189861223G0001X
MN130291223G0001X
WI6724-151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice