Provider Demographics
NPI:1669807863
Name:THOMAS, ANDREA CARRIERI (DMD)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:CARRIERI
Last Name:THOMAS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:ANDREA
Other - Middle Name:MICHELLE
Other - Last Name:CARRIERI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:1519 HERITAGE LANE
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29505
Mailing Address - Country:US
Mailing Address - Phone:843-664-8777
Mailing Address - Fax:843-667-1925
Practice Address - Street 1:1519 HERITAGE LANE
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29505
Practice Address - Country:US
Practice Address - Phone:843-664-8777
Practice Address - Fax:843-667-1925
Is Sole Proprietor?:No
Enumeration Date:2013-09-06
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8246122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist