Provider Demographics
NPI:1285800524
Name:PUDDICOMBE, ANDREA NICOLE (DMD)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:NICOLE
Last Name:PUDDICOMBE
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 1:215 WEST LIBERTY WAY
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19963
Mailing Address - Country:US
Mailing Address - Phone:302-424-7976
Mailing Address - Fax:302-424-2324
Practice Address - Street 1:215 WEST LIBERTY WAY
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:DE
Practice Address - Zip Code:19963
Practice Address - Country:US
Practice Address - Phone:302-424-7976
Practice Address - Fax:302-424-2324
Is Sole Proprietor?:No
Enumeration Date:2008-05-06
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEG3-00003511223G0001X
DEG1-0001282122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice