Provider Demographics
NPI:1447433818
Name:DR. EDWARD S. ANDOCHICK, PA
Entity type:Organization
Organization Name:DR. EDWARD S. ANDOCHICK, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:S
Authorized Official - Last Name:ANDOCHICK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-663-3919
Mailing Address - Street 1:516 TRAIL AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-4942
Mailing Address - Country:US
Mailing Address - Phone:301-663-3919
Mailing Address - Fax:301-663-1459
Practice Address - Street 1:516 TRAIL AVE
Practice Address - Street 2:SUITE B
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-4942
Practice Address - Country:US
Practice Address - Phone:301-663-3919
Practice Address - Fax:301-663-1459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-08
Last Update Date:2007-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD37301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty