Provider Demographics
NPI:1871335695
Name:D'ANDREA, KAMMIE CONRAD (DMD)
Entity type:Individual
Prefix:DR
First Name:KAMMIE
Middle Name:CONRAD
Last Name:D'ANDREA
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 1:40 E PIER DR APT 2432
Mailing Address - Street 2:
Mailing Address - City:EAST BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02128-2953
Mailing Address - Country:US
Mailing Address - Phone:239-682-4627
Mailing Address - Fax:
Practice Address - Street 1:644 AMERICAN LEGION HWY
Practice Address - Street 2:
Practice Address - City:ROSLINDALE
Practice Address - State:MA
Practice Address - Zip Code:02131-3901
Practice Address - Country:US
Practice Address - Phone:617-553-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-11
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN10000254122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist