Provider Demographics
NPI:1861125940
Name:ATHANATHIOUS, ANDREW MICHEL (DMD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:MICHEL
Last Name:ATHANATHIOUS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:723 RIVERSIDE ST APT 434
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-5937
Mailing Address - Country:US
Mailing Address - Phone:647-780-7938
Mailing Address - Fax:
Practice Address - Street 1:77 SOUTH ST
Practice Address - Street 2:
Practice Address - City:GORHAM
Practice Address - State:ME
Practice Address - Zip Code:04038-1715
Practice Address - Country:US
Practice Address - Phone:207-222-0522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-06
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDEN49891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice