Provider Demographics
NPI:1417243486
Name:ANDREW J. DYER, D.D.S., PLLC
Entity Type:Organization
Organization Name:ANDREW J. DYER, D.D.S., PLLC
Other - Org Name:DYER FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:JONATHAN
Authorized Official - Last Name:DYER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-810-7306
Mailing Address - Street 1:12648 WOLF BERRY DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79928-5267
Mailing Address - Country:US
Mailing Address - Phone:909-810-7306
Mailing Address - Fax:
Practice Address - Street 1:14505 HORIZON BLVD
Practice Address - Street 2:STE. B
Practice Address - City:HORIZON CITY
Practice Address - State:TX
Practice Address - Zip Code:79928-8564
Practice Address - Country:US
Practice Address - Phone:909-810-7306
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-28
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX250391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty