Provider Demographics
NPI:1417034471
Name:DEMEYER, ANDREW JAMES (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:JAMES
Last Name:DEMEYER
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 1:4707 MISSION BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-2535
Mailing Address - Country:US
Mailing Address - Phone:858-483-6851
Mailing Address - Fax:858-483-6412
Practice Address - Street 1:4707 MISSION BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-2535
Practice Address - Country:US
Practice Address - Phone:858-483-6851
Practice Address - Fax:858-483-6412
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA369131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice