Provider Demographics
NPI:1659463594
Name:MAESO, ANDRES SAVERO
Entity Type:Individual
Prefix:DR
First Name:ANDRES
Middle Name:SAVERO
Last Name:MAESO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 DENBIGH BLVD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23608-4413
Mailing Address - Country:US
Mailing Address - Phone:757-877-4304
Mailing Address - Fax:757-877-5028
Practice Address - Street 1:606 DENBIGH BLVD
Practice Address - Street 2:SUITE 107
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23608-4413
Practice Address - Country:US
Practice Address - Phone:757-877-4304
Practice Address - Fax:757-877-5028
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010068971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice