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General NPI Number Information
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NPI Number | 1710170634
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Entity Type | Organization
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Legal Business Name | MICHAEL J. ANDRESKI, DDS, PA
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Dates
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Enumeration Date | 08/23/2007
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Last Update Date | 08/23/2007
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Provider Practice Location Address
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Address Line | 1511 RIVER ST
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City | WILKESBORO
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State | NC
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Zip | 28697-7391
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Country | US
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Telephone | 336-667-1029
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Fax | 336-667-4155
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Provider Business Mailing Address
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Address Line | 1511 RIVER ST
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City | WILKESBORO
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State | NC
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Zip | 28697-7391
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Country | US
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Telephone | 336-667-1029
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Fax | 336-667-4155
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Authorized Official
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Title or Position | SECRETARY/TREASURER
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Name | MRS. MARY CAROL ANDRESKI
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Credential |
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Telephone | 336-667-1029
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 5790
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License Number State | NC
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