Provider Demographics
NPI:1780094052
Name:FERRARO, ANDREW (MD, DDS)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:FERRARO
Suffix:
Gender:M
Credentials:MD, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 WESTERN LN
Mailing Address - Street 2:
Mailing Address - City:WANTAGH
Mailing Address - State:NY
Mailing Address - Zip Code:11793-1208
Mailing Address - Country:US
Mailing Address - Phone:917-860-2391
Mailing Address - Fax:
Practice Address - Street 1:2964 MILLER PLACE WAY
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37924-1673
Practice Address - Country:US
Practice Address - Phone:917-860-2391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-07
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3057101223S0112X, 204E00000X
NY934444003390200000X
TN114181223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program