Provider Demographics
NPI:1851363014
Name:MASTRONARDI, ANDREW VINCENT (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:VINCENT
Last Name:MASTRONARDI
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 1:367 OLD TOWN RD
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-2256
Mailing Address - Country:US
Mailing Address - Phone:631-473-8292
Mailing Address - Fax:631-473-3896
Practice Address - Street 1:367 OLD TOWN RD
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-2256
Practice Address - Country:US
Practice Address - Phone:631-473-8292
Practice Address - Fax:631-473-3896
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043605122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist