Provider Demographics
NPI:1942402938
Name:TANCHYK, ANDREW PETER (DMD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:PETER
Last Name:TANCHYK
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 1:633 BORDENTOWN AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08879-1471
Mailing Address - Country:US
Mailing Address - Phone:732-721-5131
Mailing Address - Fax:
Practice Address - Street 1:633 BORDENTOWN AVE
Practice Address - Street 2:
Practice Address - City:SOUTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08879-1471
Practice Address - Country:US
Practice Address - Phone:732-721-5131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJD104911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice