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NPI Code Detail

MEDICARE: DR. ANDREW SOUTAR DDS

MEDICARE: DR. ANDREW SOUTAR 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
11223G0001XGeneral Practice Dentistry0587371NY
2390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1659753556
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ANDREW SOUTAR DDS
Provider Business Mailing Address
First Line : 1 BROOKDALE PLZ
Second Line :
City : BROOKLYN
State : NY
Zip : 11212-3139
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 139 FLATBUSH AVE
Second Line : SUITE 10
City : BROOKLYN
State : NY
Zip : 11217-1450
Country : US
Telephone Number : 718-622-7637
Fax Number : 718-622-7637
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/26/2015
Last Update Date : 01/13/2017

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