Provider Demographics
NPI:1710741483
Name:TINOCO IRAHETA, ANDREA BEATRIZ (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:BEATRIZ
Last Name:TINOCO IRAHETA
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 1:1012 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:WA
Mailing Address - Zip Code:99328
Mailing Address - Country:US
Mailing Address - Phone:509-382-3466
Mailing Address - Fax:509-382-2748
Practice Address - Street 1:1012 S 3RD ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:WA
Practice Address - Zip Code:99328
Practice Address - Country:US
Practice Address - Phone:509-382-3466
Practice Address - Fax:509-382-2748
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-12
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE61518007122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist