Provider Demographics
NPI:1225351810
Name:DINH, ANDREA SALAZAR (DDS)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:SALAZAR
Last Name:DINH
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 1:2111 PARKSIDE DR STE C
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94536-5209
Mailing Address - Country:US
Mailing Address - Phone:510-792-1551
Mailing Address - Fax:510-792-1554
Practice Address - Street 1:2111 PARKSIDE DR STE C
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536-5209
Practice Address - Country:US
Practice Address - Phone:510-792-1551
Practice Address - Fax:510-792-1554
Is Sole Proprietor?:No
Enumeration Date:2010-03-10
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25230122300000X
CA574231223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist