Individual
MARK PANDREA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
7140 66TH ST, GLENDALE, NY 11385
(718) 386-2312
(718) 386-6669
Mailing address
7140 66TH ST, GLENDALE, NY 11385
(718) 386-2312
(718) 386-6669
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
47005
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01759264
—
NY
Enumeration date
08/30/2006
Last updated
07/08/2007
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