Provider Demographics
NPI:1972745362
Name:SPATH, ANDREW W (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:W
Last Name:SPATH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2121 E COAST HWY STE 290
Mailing Address - Street 2:
Mailing Address - City:CORONA DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92625-1940
Mailing Address - Country:US
Mailing Address - Phone:949-612-2356
Mailing Address - Fax:949-544-5207
Practice Address - Street 1:2121 E COAST HWY STE 290
Practice Address - Street 2:
Practice Address - City:CORONA DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92625
Practice Address - Country:US
Practice Address - Phone:949-612-2356
Practice Address - Fax:949-544-5207
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-31
Last Update Date:2018-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA560091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice