Provider Demographics
NPI:1114163730
Name:JOHN, ANDREW K (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:K
Last Name:JOHN
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 1:2123 S EL CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-6202
Mailing Address - Country:US
Mailing Address - Phone:760-757-7720
Mailing Address - Fax:760-439-9534
Practice Address - Street 1:2123 S EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-6202
Practice Address - Country:US
Practice Address - Phone:760-757-7720
Practice Address - Fax:760-439-9534
Is Sole Proprietor?:No
Enumeration Date:2009-01-02
Last Update Date:2009-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA560371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice