Provider Demographics
NPI:1932245859
Name:DANDREA & PANTERA DMD PC
Entity Type:Organization
Organization Name:DANDREA & PANTERA DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:DANDREA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:203-288-0951
Mailing Address - Street 1:2675 WHITNEY AVE
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518
Mailing Address - Country:US
Mailing Address - Phone:203-288-0951
Mailing Address - Fax:203-281-1167
Practice Address - Street 1:2675 WHITNEY AVE
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518
Practice Address - Country:US
Practice Address - Phone:203-288-0951
Practice Address - Fax:203-281-1167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT006055122300000X
CT006331122300000X
CT009372122300000X
CT006208122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty