Provider Demographics
NPI:1811961444
Name:SOFEN, ANDREW P (DDS)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:P
Last Name:SOFEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2623 WORCESTER
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48323
Mailing Address - Country:US
Mailing Address - Phone:248-626-3457
Mailing Address - Fax:734-427-9700
Practice Address - Street 1:17886 FARMINGTON RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152
Practice Address - Country:US
Practice Address - Phone:734-427-8111
Practice Address - Fax:734-427-9700
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901012064122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist