Provider Demographics
NPI:1447435870
Name:DEAK, ANDREW J (MD, DMD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:J
Last Name:DEAK
Suffix:
Gender:M
Credentials:MD, DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 ABBE RD N
Mailing Address - Street 2:STE D
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-1600
Mailing Address - Country:US
Mailing Address - Phone:440-366-3325
Mailing Address - Fax:
Practice Address - Street 1:9365 OLDE 8 RD
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:OH
Practice Address - Zip Code:44067-2052
Practice Address - Country:US
Practice Address - Phone:330-467-6066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-03
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.022513122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist