Provider Demographics
NPI:1992929871
Name:DANDREA, RAYMOND LEONARD (DDS)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:LEONARD
Last Name:DANDREA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1129 WEST CHESTER PIKE
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382
Mailing Address - Country:US
Mailing Address - Phone:610-692-7868
Mailing Address - Fax:610-692-3459
Practice Address - Street 1:1129 WEST CHESTER PIKE
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19382
Practice Address - Country:US
Practice Address - Phone:610-692-7868
Practice Address - Fax:610-692-3459
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-21847-L1223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice