Provider Demographics
NPI:1083068811
Name:ZEGEER, ANDREW J
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:J
Last Name:ZEGEER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 MORRIS STREET, STE 2
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25301
Mailing Address - Country:US
Mailing Address - Phone:304-833-9033
Mailing Address - Fax:304-840-0216
Practice Address - Street 1:112 MORRIS STREET, STE 2
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301
Practice Address - Country:US
Practice Address - Phone:304-833-9033
Practice Address - Fax:304-840-0216
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-18
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY9889122300000X
WV44261223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty
No122300000XDental ProvidersDentistGroup - Single Specialty