Provider Demographics
NPI:1164449005
Name:DIKO, DIKO ANDROUS (DDS)
Entity Type:Individual
Prefix:DR
First Name:DIKO
Middle Name:ANDROUS
Last Name:DIKO
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 1:3848 MCHENRY AVE STE 130
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95356-1599
Mailing Address - Country:US
Mailing Address - Phone:209-523-2100
Mailing Address - Fax:209-523-2101
Practice Address - Street 1:3848 MCHENRY AVE STE 130
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95356-1599
Practice Address - Country:US
Practice Address - Phone:209-523-2100
Practice Address - Fax:209-523-2101
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA495111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB49511-01OtherDELTADENTAL OF CALIFORNIA
CAG93045-01OtherDENTI-CAL