Provider Demographics
NPI:1336211416
Name:FOLEY, ANDREA M (DMD)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:M
Last Name:FOLEY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2016 VADALABENE DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:MARYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62062-6901
Mailing Address - Country:US
Mailing Address - Phone:618-288-9670
Mailing Address - Fax:618-288-9679
Practice Address - Street 1:2016 VADALABENE DR
Practice Address - Street 2:SUITE C
Practice Address - City:MARYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62062-6901
Practice Address - Country:US
Practice Address - Phone:618-288-9670
Practice Address - Fax:618-288-9679
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190268041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice