Provider Demographics
NPI:1033539606
Name:MARECHEK, ANDREI (MD, DDS)
Entity Type:Individual
Prefix:
First Name:ANDREI
Middle Name:
Last Name:MARECHEK
Suffix:
Gender:M
Credentials:MD, DDS
Other - Prefix:
Other - First Name:ANDREI
Other - Middle Name:
Other - Last Name:MENIAILENKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 S ALAMEDA ST UNIT 140
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90012-3930
Mailing Address - Country:US
Mailing Address - Phone:858-361-9456
Mailing Address - Fax:
Practice Address - Street 1:3535 PERKINS RD STE 345
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-2293
Practice Address - Country:US
Practice Address - Phone:225-747-0181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-23
Last Update Date:2021-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30-024392122300000X
LA69731223S0112X, 204E00000X
CA104868204E00000X
OH30-024392204E00000X
390200000X
CAA169364204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No122300000XDental ProvidersDentist
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program