Provider Demographics
NPI:1124177480
Name:ANDRES, LORETTA JEAN (DDS)
Entity type:Individual
Prefix:DR
First Name:LORETTA
Middle Name:JEAN
Last Name:ANDRES
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:LORI
Other - Middle Name:J
Other - Last Name:ANDRES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LORI ANDRES
Mailing Address - Street 1:332 WOODSIDE RD
Mailing Address - Street 2:
Mailing Address - City:WEST BARNSTABLE
Mailing Address - State:MA
Mailing Address - Zip Code:02668-1736
Mailing Address - Country:US
Mailing Address - Phone:508-420-0051
Mailing Address - Fax:
Practice Address - Street 1:15 CEDAR ST
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-3009
Practice Address - Country:US
Practice Address - Phone:508-790-7801
Practice Address - Fax:508-775-5607
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA169411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice