Provider Demographics
NPI:1053853002
Name:PIERCE, ANDREA (DMD)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:PIERCE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIT 7095 BOX 185
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09824-7095
Mailing Address - Country:US
Mailing Address - Phone:314-676-6368
Mailing Address - Fax:
Practice Address - Street 1:UNIT 7095 BOX 185
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09824-7095
Practice Address - Country:US
Practice Address - Phone:314-676-6368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-08
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0149561223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice