Provider Demographics
NPI:1902829351
Name:MESAROS, ANDREW JOSEPH JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:JOSEPH
Last Name:MESAROS
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1413 EDENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45434-6821
Mailing Address - Country:US
Mailing Address - Phone:937-431-5446
Mailing Address - Fax:
Practice Address - Street 1:360 WILSON DR
Practice Address - Street 2:
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385-1810
Practice Address - Country:US
Practice Address - Phone:937-374-5600
Practice Address - Fax:937-374-5692
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV28371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice