Provider Demographics
NPI:1841201225
Name:LAPRADE, ANDRE J (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANDRE
Middle Name:J
Last Name:LAPRADE
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 1:123 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-4203
Mailing Address - Country:US
Mailing Address - Phone:401-728-0150
Mailing Address - Fax:401-729-4960
Practice Address - Street 1:123 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-4203
Practice Address - Country:US
Practice Address - Phone:401-728-0150
Practice Address - Fax:401-729-4960
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI23071223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI89984OtherBLUE CROSS DENTAL
BL2910429OtherDEA NUMBER
RIAL05280Medicare ID - Type Unspecified