Provider Demographics
NPI:1043317720
Name:GAMACHE, ANDREW D (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:D
Last Name:GAMACHE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:306 WALNUT AVE STE 31
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-4936
Mailing Address - Country:US
Mailing Address - Phone:619-220-0866
Mailing Address - Fax:619-220-0870
Practice Address - Street 1:306 WALNUT AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-4978
Practice Address - Country:US
Practice Address - Phone:619-220-0866
Practice Address - Fax:619-220-0870
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2023-08-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX234481223G0001X
CA542551223G0001X, 207QS1201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS1201XAllopathic & Osteopathic PhysiciansFamily MedicineSleep Medicine
No1223G0001XDental ProvidersDentistGeneral Practice