Healthcare Provider Details

I. General information

NPI: 1164165205
Provider Name (Legal Business Name): ANDREA ROSE GERCHMAN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2022
Last Update Date: 07/08/2023
Certification Date: 07/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

329 S MAIN ST
CANANDAIGUA NY
14424-2118
US

IV. Provider business mailing address

2001 BERNARD BLVD
ENDICOTT NY
13760-1412
US

V. Phone/Fax

Practice location:
  • Phone: 585-394-1930
  • Fax:
Mailing address:
  • Phone: 607-341-6533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number063125
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: