Healthcare Provider Details

I. General information

NPI: 1053853002
Provider Name (Legal Business Name): ANDREA PIERCE DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2016
Last Update Date: 07/25/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIT 7095 BOX 185
APO AE
09824-7095
US

IV. Provider business mailing address

UNIT 7095 BOX 185
APO AE
09824-7095
US

V. Phone/Fax

Practice location:
  • Phone: 314-676-6368
  • Fax:
Mailing address:
  • Phone: 314-676-6368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN014956
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN014956
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: