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General NPI Number Information
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NPI Number | 1629434410
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Entity Type | Individual
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Provider Name | MARK S ANDRAWIS D.M.D
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Gender | Male
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Dates
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Enumeration Date | 01/08/2016
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Last Update Date | 11/08/2016
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Provider Practice Location Address
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Address Line | 5 BECKER FARM RD SUITE 101
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City | ROSELAND
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State | NJ
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Zip | 07068-1741
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Country | US
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Telephone | 973-974-9490
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Fax | 973-974-9491
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Provider Business Mailing Address
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Address Line | 5 BECKER FARM RD SUITE 101
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City | ROSELAND
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State | NJ
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Zip | 07068-1741
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Country | US
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Telephone | 973-974-9490
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Fax | 973-974-9491
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 22DI02556300
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 058823-1
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DEN.00203003
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License Number State | CO
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Taxonomy #4
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 040145409
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License Number State | VA
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