Provider Demographics
NPI:1033328398
Name:ANDRADA, VICTORIA BETHINA (DDS)
Entity Type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:BETHINA
Last Name:ANDRADA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:VICTORIA
Other - Middle Name:BETHINA
Other - Last Name:SAZON ANDRADA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:2542 BERRYESSA ROAD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95132
Mailing Address - Country:US
Mailing Address - Phone:408-926-8600
Mailing Address - Fax:
Practice Address - Street 1:2542 BERRYESSA ROAD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95132
Practice Address - Country:US
Practice Address - Phone:408-926-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40881122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6514OtherPACIFIC UNION DENTAL