MEDICARE: DR. JAMES C ANDREA DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	D10099	MN

General Provider Information

NPI Number	:	1134270929
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES C ANDREA DDS

Provider Business Mailing Address
First Line	:	1230 COUNTY RD E E
Second Line	:
City	:	VADNAIS HEIGHTS
State	:	MN
Zip	:	55110-5132
Country	:	US
Telephone Number	:	651-482-0180
Fax Number	:

Provider Business Practice Location Address
First Line	:	1230 COUNTY ROAD E E
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55110-5132
Country	:	US
Telephone Number	:	651-482-0180
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	07/08/2007

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