Provider Demographics
NPI:1346759487
Name:ANDES DENTAL PLLC
Entity Type:Organization
Organization Name:ANDES DENTAL PLLC
Other - Org Name:ODESSA FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KEERTHI
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRYALA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:832-762-1914
Mailing Address - Street 1:1157 E 42ND ST STE A
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79762-7723
Mailing Address - Country:US
Mailing Address - Phone:432-242-6666
Mailing Address - Fax:832-379-5175
Practice Address - Street 1:1157 E 42ND ST STE A
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79762-7723
Practice Address - Country:US
Practice Address - Phone:432-242-6666
Practice Address - Fax:832-379-5175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty