Provider Demographics
NPI:1174191001
Name:ANDREW COMBS, D.D.S., INC.
Entity Type:Organization
Organization Name:ANDREW COMBS, D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SHAREHOLDER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:JAMISON
Authorized Official - Last Name:COMBS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:559-908-8104
Mailing Address - Street 1:2101 SAN GABRIEL AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-4148
Mailing Address - Country:US
Mailing Address - Phone:559-908-3711
Mailing Address - Fax:
Practice Address - Street 1:6623 N RIVERSIDE DR STE 101
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93722-9325
Practice Address - Country:US
Practice Address - Phone:559-696-5437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-16
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental