MEDICARE: DR. LAWRENCE J ANDRUS 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	122300000X	Dentist	3265	CT

General Provider Information

NPI Number	:	1790895431
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAWRENCE J ANDRUS DDS

Provider Business Mailing Address
First Line	:	469 BUCKLAND RD
Second Line	:
City	:	SOUTH WINDSOR
State	:	CT
Zip	:	06074-3737
Country	:	US
Telephone Number	:	860-644-1826
Fax Number	:	860-644-2192

Provider Business Practice Location Address
First Line	:	469 BUCKLAND RD
Second Line	:
City	:	SOUTH WINDSOR
State	:	CT
Zip	:	06074-3737
Country	:	US
Telephone Number	:	860-644-1826
Fax Number	:	860-644-2192

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	07/08/2007

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