=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750554192
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MYRNA N ANDRAWES DMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/07/2008
-----------------------------------------------------
Last Update Date | 02/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 219 HALF ACRE RD
-----------------------------------------------------
City | MONROE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08831
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-655-7400
-----------------------------------------------------
Fax | 609-655-7477
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 219 HALF ACRE RD
-----------------------------------------------------
City | MONROE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08831
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-655-7400
-----------------------------------------------------
Fax | 609-655-7477
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 22DI02273000
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------