Healthcare Provider Details

I. General information

NPI: 1467703900
Provider Name (Legal Business Name): ANDREA SUE BEDELL DTH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2012
Last Update Date: 09/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24323 N HICKORY NUT GROVE RD
CARY IL
60013-9603
US

IV. Provider business mailing address

24323 N HICKORY NUT GROVE RD
CARY IL
60013-9603
US

V. Phone/Fax

Practice location:
  • Phone: 847-516-8411
  • Fax:
Mailing address:
  • Phone: 847-516-8411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: