MEDICARE: DR. ANDREW LAWRENCE PUTTER D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	D19515	NJ

General Provider Information

NPI Number	:	1124457429
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREW LAWRENCE PUTTER D.M.D.

Provider Business Mailing Address
First Line	:	410 N BROADWAY
Second Line	:
City	:	PITMAN
State	:	NJ
Zip	:	08071-1047
Country	:	US
Telephone Number	:	856-589-3803
Fax Number	:	856-589-0371

Provider Business Practice Location Address
First Line	:	410 N BROADWAY
Second Line	:
City	:	PITMAN
State	:	NJ
Zip	:	08071-1047
Country	:	US
Telephone Number	:	856-589-3803
Fax Number	:	856-589-0371

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/06/2013
Last Update Date	:	11/06/2013

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