Provider Demographics
NPI:1821435223
Name:DIVERNIERI, ANDREA P (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:P
Last Name:DIVERNIERI
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 1:22 HILLTOP TER
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-1109
Mailing Address - Country:US
Mailing Address - Phone:718-987-1527
Mailing Address - Fax:
Practice Address - Street 1:22 HILLTOP TER
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-1109
Practice Address - Country:US
Practice Address - Phone:718-987-1527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-27
Last Update Date:2013-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040253122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist