Provider Demographics
NPI:1235443391
Name:DAVONG, ANDY (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDY
Middle Name:
Last Name:DAVONG
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 1:7406 STATE HIGHWAY 66
Mailing Address - Street 2:
Mailing Address - City:ROYSE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:75189-4166
Mailing Address - Country:US
Mailing Address - Phone:972-460-4422
Mailing Address - Fax:469-723-3237
Practice Address - Street 1:7406 W. STATE HIGHWAY 66
Practice Address - Street 2:
Practice Address - City:ROYSE CITY
Practice Address - State:TX
Practice Address - Zip Code:75189-4166
Practice Address - Country:US
Practice Address - Phone:972-460-4422
Practice Address - Fax:469-723-3237
Is Sole Proprietor?:No
Enumeration Date:2010-07-31
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25750122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist