MEDICARE: DR. EMILY ANDRE DMD, NMD, IBDM

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	DN 18986	FL
2	1223G0001X	General Practice Dentistry	6724-15	WI
3	1223G0001X	General Practice Dentistry	13029	MN

General Provider Information

NPI Number	:	1659682409
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EMILY ANDRE DMD, NMD, IBDM

Provider Business Mailing Address
First Line	:	1813 WILSON ST
Second Line	:
City	:	MENOMONIE
State	:	WI
Zip	:	54751-1406
Country	:	US
Telephone Number	:	715-600-9004
Fax Number	:

Provider Business Practice Location Address
First Line	:	109 OAK AVE
Second Line	:
City	:	MENOMONIE
State	:	WI
Zip	:	54751-1363
Country	:	US
Telephone Number	:	715-600-9004
Fax Number	:

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

Provider Enumeration Date	:	06/27/2010
Last Update Date	:	06/09/2026

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