Provider Demographics
NPI:1396375812
Name:MUNOZ DE ANDA, EURIDISE (DDS)
Entity Type:Individual
Prefix:
First Name:EURIDISE
Middle Name:
Last Name:MUNOZ DE ANDA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:EURIDISE
Other - Middle Name:
Other - Last Name:MUNOZ DE ANDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:3311 WATT AVE STE A
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95821-3617
Mailing Address - Country:US
Mailing Address - Phone:916-857-1202
Mailing Address - Fax:
Practice Address - Street 1:3311 WATT AVE STE A
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95821-3617
Practice Address - Country:US
Practice Address - Phone:916-857-1202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-23
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103551122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist