Provider Demographics
NPI:1831180512
Name:ANDREEN, AVIVA LOUISE (DDS)
Entity type:Individual
Prefix:DR
First Name:AVIVA
Middle Name:LOUISE
Last Name:ANDREEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1273 NORTH AVE
Mailing Address - Street 2:BLDG 3 APT 4A5
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10804-2702
Mailing Address - Country:US
Mailing Address - Phone:646-245-3790
Mailing Address - Fax:
Practice Address - Street 1:1273 NORTH AVE
Practice Address - Street 2:BLDG 3 APT 4A5
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10804-2702
Practice Address - Country:US
Practice Address - Phone:646-245-3790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI2246300122300000X
NY047965122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist