Provider Demographics
NPI:1003541541
Name:ANDRINO, JOSE ANDRES (DDS)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:ANDRES
Last Name:ANDRINO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 E SOUTHERN AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-5258
Mailing Address - Country:US
Mailing Address - Phone:480-737-1125
Mailing Address - Fax:480-779-1312
Practice Address - Street 1:1801 E SOUTHERN AVE STE 101
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-5258
Practice Address - Country:US
Practice Address - Phone:480-892-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-19
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD011517122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist