Provider Demographics
NPI:1194388231
Name:ANDREW SPATH DDS, INC
Entity Type:Organization
Organization Name:ANDREW SPATH DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:SPATH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-612-2356
Mailing Address - Street 1:2121 E COAST HWY STE 290
Mailing Address - Street 2:
Mailing Address - City:CORONA DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92625-1940
Mailing Address - Country:US
Mailing Address - Phone:949-612-2356
Mailing Address - Fax:949-544-5207
Practice Address - Street 1:2121 E COAST HWY STE 290
Practice Address - Street 2:
Practice Address - City:CORONA DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92625-1940
Practice Address - Country:US
Practice Address - Phone:949-612-2356
Practice Address - Fax:949-544-5207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-15
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental