Provider Demographics
NPI:1053531277
Name:ANDREW DO DENTISTRY
Entity type:Organization
Organization Name:ANDREW DO DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:THUC
Authorized Official - Last Name:DO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-573-3261
Mailing Address - Street 1:625 E VALLEY BLVD STE K
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-3591
Mailing Address - Country:US
Mailing Address - Phone:626-573-3261
Mailing Address - Fax:626-573-3210
Practice Address - Street 1:625 E VALLEY BLVD STE K
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-3591
Practice Address - Country:US
Practice Address - Phone:626-573-3261
Practice Address - Fax:626-573-3210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA458511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty