Provider Demographics
NPI:1609930049
Name:ANDRADA, WALTER D (DDS)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:D
Last Name:ANDRADA
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 1:9330 CARMEL MOUNTAIN RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-2157
Mailing Address - Country:US
Mailing Address - Phone:858-780-0818
Mailing Address - Fax:858-780-0156
Practice Address - Street 1:9330 CARMEL MOUNTAIN RD
Practice Address - Street 2:SUITE B
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92129-2157
Practice Address - Country:US
Practice Address - Phone:858-780-0818
Practice Address - Fax:858-780-0156
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA409121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice