Provider Demographics
NPI:1346514106
Name:ANDALON, DARRELL ORTIZ (DDS)
Entity Type:Individual
Prefix:DR
First Name:DARRELL
Middle Name:ORTIZ
Last Name:ANDALON
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 1:8202 FLORENCE AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90240-3937
Mailing Address - Country:US
Mailing Address - Phone:562-861-8807
Mailing Address - Fax:
Practice Address - Street 1:8202 FLORENCE AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90240-3937
Practice Address - Country:US
Practice Address - Phone:562-861-8807
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-26
Last Update Date:2012-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA611991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice