Provider Demographics
NPI:1255180725
Name:ANDRINGA, JOSEPH T
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:T
Last Name:ANDRINGA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 W 157TH ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH HOLLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60473-1209
Mailing Address - Country:US
Mailing Address - Phone:708-752-0246
Mailing Address - Fax:
Practice Address - Street 1:101 CAMELOT DR STE 3
Practice Address - Street 2:
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54935-8048
Practice Address - Country:US
Practice Address - Phone:708-752-0246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-16
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6001601-151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice