Provider Demographics
NPI:1508175332
Name:SHORE, ANDREW M (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:M
Last Name:SHORE
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 1:519 CHESTER PIKE
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19074-1416
Mailing Address - Country:US
Mailing Address - Phone:610-532-3700
Mailing Address - Fax:610-532-9842
Practice Address - Street 1:519 CHESTER PIKE
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:PA
Practice Address - Zip Code:19074-1416
Practice Address - Country:US
Practice Address - Phone:610-532-3700
Practice Address - Fax:610-532-9842
Is Sole Proprietor?:No
Enumeration Date:2010-09-28
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS038508122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist