Provider Demographics
NPI:1790901775
Name:NGO, ANDREW QUANG (DDS)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:QUANG
Last Name:NGO
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 1:1897 ALUM ROCK AVE STE 10
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-1371
Mailing Address - Country:US
Mailing Address - Phone:408-251-5400
Mailing Address - Fax:408-251-6463
Practice Address - Street 1:1897 ALUM ROCK AVE STE 10
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1371
Practice Address - Country:US
Practice Address - Phone:408-251-5400
Practice Address - Fax:408-251-6463
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA499471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice