Provider Demographics
NPI:1922770817
Name:ANDY P. DUONG DDS PC
Entity Type:Organization
Organization Name:ANDY P. DUONG DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:DUONG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:415-812-3642
Mailing Address - Street 1:4440 SAN PABLO DAM RD STE C
Mailing Address - Street 2:
Mailing Address - City:EL SOBRANTE
Mailing Address - State:CA
Mailing Address - Zip Code:94803-3052
Mailing Address - Country:US
Mailing Address - Phone:510-223-4311
Mailing Address - Fax:
Practice Address - Street 1:4440 SAN PABLO DAM RD STE C
Practice Address - Street 2:
Practice Address - City:EL SOBRANTE
Practice Address - State:CA
Practice Address - Zip Code:94803-3052
Practice Address - Country:US
Practice Address - Phone:510-223-4311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-29
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental