Provider Demographics
NPI:1235202219
Name:DE CARDENAS, ANDRES ANTONIO (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANDRES
Middle Name:ANTONIO
Last Name:DE CARDENAS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9000 SW 152ND ST
Mailing Address - Street 2:SUITE 108
Mailing Address - City:VILLAGE OF PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-1981
Mailing Address - Country:US
Mailing Address - Phone:305-251-3335
Mailing Address - Fax:305-251-6710
Practice Address - Street 1:9000 SW 152ND ST
Practice Address - Street 2:SUITE 108
Practice Address - City:VILLAGE OF PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-1981
Practice Address - Country:US
Practice Address - Phone:305-251-3335
Practice Address - Fax:305-251-6710
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN-138581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL65-0575883OtherTAX IDENTIFICATION NUMBER
FL65-0575883OtherTAX IDENTIFICATION NUMBER
MA291249Medicare UPIN
FL000852125Medicare UPIN