Provider Demographics
NPI:1427652627
Name:GOODEMOTE, ANDREW ROBERT (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:ROBERT
Last Name:GOODEMOTE
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 MOHAWK TRL
Mailing Address - Street 2:
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804-9045
Mailing Address - Country:US
Mailing Address - Phone:518-232-5757
Mailing Address - Fax:
Practice Address - Street 1:10 NOSBAND AVE STE 1M
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-2082
Practice Address - Country:US
Practice Address - Phone:914-313-3225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-28
Last Update Date:2020-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0613521223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics