Provider Demographics
NPI:1568743839
Name:FERREIRA ZANDONA, ANDREA G (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:G
Last Name:FERREIRA ZANDONA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 W 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43210-1267
Mailing Address - Country:US
Mailing Address - Phone:614-292-1472
Mailing Address - Fax:614-688-3553
Practice Address - Street 1:OHIO STATE DENTAL FACILITY PRACTICE
Practice Address - Street 2:305 W. 12TH AVE., ROOM 2301
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210-1267
Practice Address - Country:US
Practice Address - Phone:614-292-1472
Practice Address - Fax:614-688-3553
Is Sole Proprietor?:No
Enumeration Date:2011-08-31
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADF11903122300000X
NC2000025400379122300000X
OH71.0002821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1568743839Medicaid