Andrea Baeder, DMD
Individual provider Active NPI General Practice Dentistry · Fort Drum, NY
NPI 1417434341 · NPPES record last updated Mar 13, 2023
Key facts
- NPI
- 1417434341
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 1001811-15 (WI)
- Practice address
- 10590 Enduring Freedom Dr
Fort Drum, NY 13602-5503 - Phone
- (315) 772-5576
- NPI assigned
- Jul 24, 2018
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1001811-15 | WI | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Guthrie Ahc | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 1001811-15 | WI | |
| General Practice Dentistry | 1223G0001X | 1001811-15 | WI | Yes |
Addresses
Primary practice location
10590 Enduring Freedom Dr
Fort Drum, NY 13602-5503
Mailing address
10590 Enduring Freedom Dr
Fort Drum, NY 13602-5503
Other providers in Fort Drum, NY
- Kim Marie Aquino
- Peter Saulius Armanas
- Tatyana Armstead
- Anne Ashley
- Matthew Marcos Bacca
- Leonard Joseph Bailey Jr.
- Tara A M Baird
- Jenna Katherine Barr
- Alec Barrowcliff
- Alfred Michael Babia Barrozo
All providers in Fort Drum, NY · General Practice Dentistry in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 13, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.