Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 22DI02314500 | NJ |
NPI | 1003954736 |
---|---|
Provider Name | Dr. Andrea Lee Mann |
First Address | Basking Ridge, NJ 07920-1686 |
Second Address | Basking Ridge, NJ 07920-1686 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2007 |
Last Update Date | 12/05/2021 |