Provider Demographics
NPI:1124457429
Name:PUTTER, ANDREW LAWRENCE (DMD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:LAWRENCE
Last Name:PUTTER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:ANDREW
Other - Middle Name:LAWRENCE
Other - Last Name:PUTTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:410 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:PITMAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08071-1047
Mailing Address - Country:US
Mailing Address - Phone:856-589-3803
Mailing Address - Fax:856-589-0371
Practice Address - Street 1:410 N BROADWAY
Practice Address - Street 2:
Practice Address - City:PITMAN
Practice Address - State:NJ
Practice Address - Zip Code:08071-1047
Practice Address - Country:US
Practice Address - Phone:856-589-3803
Practice Address - Fax:856-589-0371
Is Sole Proprietor?:No
Enumeration Date:2013-11-06
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJD19515122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist