Provider Demographics
NPI:1518576461
Name:CASALLAS, ANDRES FELIPE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDRES
Middle Name:FELIPE
Last Name:CASALLAS
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 1:9229 REGENTS RD UNIT 216
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-9272
Mailing Address - Country:US
Mailing Address - Phone:510-754-9754
Mailing Address - Fax:
Practice Address - Street 1:949 PALM AVE
Practice Address - Street 2:
Practice Address - City:IMPERIAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:91932-1503
Practice Address - Country:US
Practice Address - Phone:619-429-3733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-27
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1051121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice