Provider Demographics
NPI:1053472365
Name:ANDIRIOUS, CLARA NANCY (DDS)
Entity Type:Individual
Prefix:
First Name:CLARA
Middle Name:NANCY
Last Name:ANDIRIOUS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6472 CAMDEN AVE.
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95120
Mailing Address - Country:US
Mailing Address - Phone:408-997-9027
Mailing Address - Fax:408-997-7852
Practice Address - Street 1:6472 CAMDEN AVE.
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95120
Practice Address - Country:US
Practice Address - Phone:408-997-9027
Practice Address - Fax:408-997-7852
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA515451223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG93394-01Medicaid