Provider Demographics
NPI:1841795598
Name:CORDIDO ENRIQUEZ, ANDREINA (DDS MS PROSTHODONTIS)
Entity Type:Individual
Prefix:
First Name:ANDREINA
Middle Name:
Last Name:CORDIDO ENRIQUEZ
Suffix:
Gender:F
Credentials:DDS MS PROSTHODONTIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7709 SAN JACINTO PL STE 200
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-3407
Mailing Address - Country:US
Mailing Address - Phone:469-466-2371
Mailing Address - Fax:
Practice Address - Street 1:7709 SAN JACINTO PL STE 200
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-3407
Practice Address - Country:US
Practice Address - Phone:469-466-2371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-26
Last Update Date:2021-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX338081223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics