Provider Demographics
NPI:1962433979
Name:IANNADREA, JEAN MARIE (DDS)
Entity type:Individual
Prefix:DR
First Name:JEAN
Middle Name:MARIE
Last Name:IANNADREA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MS
Other - First Name:PATRICIA
Other - Middle Name:B
Other - Last Name:URBANIAK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:200 CENTER ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CHARDON
Mailing Address - State:OH
Mailing Address - Zip Code:44024-1122
Mailing Address - Country:US
Mailing Address - Phone:440-975-0800
Mailing Address - Fax:440-285-2323
Practice Address - Street 1:200 CENTER ST
Practice Address - Street 2:SUITE 3
Practice Address - City:CHARDON
Practice Address - State:OH
Practice Address - Zip Code:44024-1122
Practice Address - Country:US
Practice Address - Phone:440-975-0800
Practice Address - Fax:440-285-2323
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH189061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice