Provider Demographics
NPI:1376058123
Name:ANDRADE DENTAL FAMILY, INC.
Entity Type:Organization
Organization Name:ANDRADE DENTAL FAMILY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDRADE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-893-7571
Mailing Address - Street 1:5885 LAMPSON AVE
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92845-2007
Mailing Address - Country:US
Mailing Address - Phone:714-893-7571
Mailing Address - Fax:
Practice Address - Street 1:5885 LAMPSON AVE
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92845-2007
Practice Address - Country:US
Practice Address - Phone:714-893-7571
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-01
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30330261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental