Provider Demographics
NPI:1568663805
Name:CONRAD, ANDREA SUE (DMD)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:SUE
Last Name:CONRAD
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 1:800 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47710-1938
Mailing Address - Country:US
Mailing Address - Phone:812-425-4206
Mailing Address - Fax:812-423-4466
Practice Address - Street 1:960 S HEBRON AVE
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-4081
Practice Address - Country:US
Practice Address - Phone:812-473-1900
Practice Address - Fax:812-471-1487
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011098122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist