Provider Demographics
NPI:1841371754
Name:JOHN J. ANDRE, D.D.S., P.C. AND ASSOCIATES
Entity type:Organization
Organization Name:JOHN J. ANDRE, D.D.S., P.C. AND ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:ANDRE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, PC
Authorized Official - Phone:804-346-8330
Mailing Address - Street 1:10863 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-3312
Mailing Address - Country:US
Mailing Address - Phone:804-346-8330
Mailing Address - Fax:
Practice Address - Street 1:10863 W BROAD ST
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-3312
Practice Address - Country:US
Practice Address - Phone:804-346-8330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010068011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty