Provider Demographics
NPI:1417549395
Name:ANDRESEN PROSTHODONTICS LLC
Entity Type:Organization
Organization Name:ANDRESEN PROSTHODONTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDRESEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-893-3867
Mailing Address - Street 1:1601 LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-3464
Mailing Address - Country:US
Mailing Address - Phone:775-323-3574
Mailing Address - Fax:
Practice Address - Street 1:1601 LAKESIDE DR
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-3464
Practice Address - Country:US
Practice Address - Phone:775-323-3574
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-11
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty