Provider Demographics
NPI:1619609872
Name:CONDE, ANDRES (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDRES
Middle Name:
Last Name:CONDE
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 1:1508 BARTON RD # 230
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-1410
Mailing Address - Country:US
Mailing Address - Phone:619-732-6633
Mailing Address - Fax:
Practice Address - Street 1:44853 PORTOLA AVE STE B
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-3703
Practice Address - Country:US
Practice Address - Phone:619-732-6633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-27
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA107547122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist