MEDICARE: DR. ANDREA LYNN DOPP D.D.S.

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	390200000X	Student in an Organized Health Care Education/Training Program
2	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	2901020660	MI

General Provider Information

NPI Number	:	1558620252
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREA LYNN DOPP D.D.S.

Provider Business Mailing Address
First Line	:	41238 CLAIRPOINTE ST
Second Line	:
City	:	HARRISON TOWNSHIP
State	:	MI
Zip	:	48045-5913
Country	:	US
Telephone Number	:	586-855-9009
Fax Number	:

Provider Business Practice Location Address
First Line	:	41238 CLAIRPOINTE ST
Second Line	:
City	:	HARRISON TOWNSHIP
State	:	MI
Zip	:	48045-5913
Country	:	US
Telephone Number	:	586-855-9009
Fax Number	:

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

Provider Enumeration Date	:	05/15/2012
Last Update Date	:	06/11/2014

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