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General NPI Number Information
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NPI Number | 1821489584
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Entity Type | Individual
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Provider Name | ANDREW SYVERTSEN DDS
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Gender | Male
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Dates
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Enumeration Date | 02/16/2015
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Last Update Date | 07/01/2019
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Provider Practice Location Address
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Address Line | 29 N AIRMONT RD STE 22
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City | SUFFERN
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State | NY
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Zip | 10901-4242
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Country | US
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Telephone | 845-369-3703
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Fax |
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Provider Business Mailing Address
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Address Line | 1510 LEXINGTON AVE APT 9E
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City | NEW YORK
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State | NY
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Zip | 10029-7161
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Country | US
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Telephone | 732-674-8649
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Fax |
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 058939
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License Number State | NY
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