Healthcare Provider Details

I. General information

NPI: 1124457429
Provider Name (Legal Business Name): ANDREW LAWRENCE PUTTER D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ANDREW LAWRENCE PUTTER D.M.D.

II. Dates (important events)

Enumeration Date: 11/06/2013
Last Update Date: 11/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 N BROADWAY
PITMAN NJ
08071-1047
US

IV. Provider business mailing address

410 N BROADWAY
PITMAN NJ
08071-1047
US

V. Phone/Fax

Practice location:
  • Phone: 856-589-3803
  • Fax: 856-589-0371
Mailing address:
  • Phone: 856-589-3803
  • Fax: 856-589-0371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD19515
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: